Radiation

So, my excellent neuro-oncologist has indicated, depending on the outcome of the surgery, radiation treatment may not be necessary. She shared an article by Almefty (2007), where on page 2465, he says the following:

“Radiotherapy has significant risks such as brain necrosis, blindness, demyelination, and radiation-induced tumor or malignant transformation. These risks may be avoided in patients with grade I or grade II chondrosarcomas when complete surgical resection is achieved.” (ibid.)

My also-excellent neurosurgeon already explained that radiation treatment would almost certainly cost me the hearing in my left ear, so we know that’s on the table. It’s also true that the other side effects of radiation, even proton radiation, are potentially troubling and could negatively impact my quality of life.

On the other hand, I’ve been doing a lot of reading about chondrosarcomas, and all the other journal articles I’ve found are pretty strongly in favor of radiation because the evidence suggests it significantly decreases the likelihood of recurrence. I found Bloch’s (2009, 2010) research on survival (2009) and recurrence (2010) rates for different treatment types especially compelling – his sample sizes for such a rare type of cancer were very good, and I feel positively about his research design. Per his 2010 article on recurrence:

“A total of 161 patients had surgery alone, and 325 patients had surgery in addition to postoperative adjuvant radiation therapy. Additionally, 46 patients underwent radiation therapy alone without surgical resection. The recurrence rate was higher in the group of patients that had surgery alone compared with surgery and radiation (44% versus 9%, p < 0.0001; Fig. ​Fig.1).1). Unexpectedly, the rate of recurrence in patients undergoing radiation alone was also significantly lower than in patients undergoing surgery alone (19% versus 44%, p = 0.036) but significantly higher than in patients who had combined surgery and radiation (19% versus 9%, p = 0.011; Fig. ​Fig.11).” (ibid.)

Because I liked his research design, I followed up with Bloch, who was kind enough to respond to my email. He felt strongly that evidence indicates resection followed by radiation results in the best long-term outcomes, both in terms of morbidity and mortality. He pointed out that Almefty’s work comes from a school of thought that tends to favor more comprehensive resection without radiation.

So, we won’t know whether it’s necessary to make this decision until after the surgery, but knowing where the neurosurgeon lands on this issue is relevant, because if he favors Almefty’s point of view, he may be inclined to remove more tissue, and if he favors Bloch’s point of view, he’ll be more likely to remove less and follow up with radiation. My guess is that he’s a Bloch man, based on our initial discussion. It’s worth some additional follow-up.