This webinar was supported by the knowledge and expertise of:
During the live event, we received some questions from the audience that we did not get to respond life so we asked our panelists for their answers. Please see them below:
Responses from Professor Kalamarides
Which has the higher rate of success in preserving hearing, radiotherapy or Avastin? (Question from Michael Raj): Avastin which can even improve hearing in some cases. However, the effect of tumor control and hearing preservation /improvement is linked to continuous treatment and if it is stopped, regrowth can occur in the following months.
Do the studies show any difference in hearing preservation in Gamma vs Proton Beam? (Question from Jon Kantor): the number of published studies on hearing preservation with Proton Beam is very low and nothing in NF2. Moreover, Proton Beam is used for larger tumors when the goal is not hearing preservation but rather tumor control (to avoid facial palsy and brainstem compression)
Do any of the professors know if Avastin causes increased protein in the kidneys and is there any way to balance that? My kidney specialist says the benefits outweigh the risks and my NF2 Dr says the opposite. (Question from CJ HETLE): Indeed, the most frequent side-effect is proteinuria, depending on the long-term use, needing to use the lowest efficient dosage. The risk is higher in older patients with hypertension and kidney problem. Low and stable proteinuria is not a problem under treatment is frequent and not a problem. The progressive increase is problematic because of the theoretical risk of permanent renal dysfunction (exceptional in NF2? not seen by myself but cited in literature). Should be evaluated by specialists. When proteinuria arises, it disappears with the discontinuation of Avastin
Responses from Doctor Lunsford
Is there any experience treating femoral nerve schwannomas with radiation? (Question from Elena Beyhaut): It has been used for brachial (arm)plexus tumors but treatment for the femoral nerve is out of my knowledge base
At what size tumor in the ear canal will radiotherapy be advisable? (Question from Michael Raj): Smaller tumors with preserved hearing do best. We treat tumors of all sizes but bigger tumors causing severe balance issues or headaches may need partial removal first
Would Gamma work better on quickly growing tumors versus slower ones? (Question from Barbara Franklin): It has been used for both types of tumors
I was always told that radiation to the tumors on my hearing nerves will 100% remove my hearing… why are these conflicting opinions out there. It’s the only thing I’ve heard. (Question from Laura Wood): This disinformation is unfortunate. In general tumor surgical removal is associated with complete hearing loss at that time. We have found that in patients with useful hearing over 50% have preservation at 10 years but only one of three by 15- 20 years, so there is a risk of late hearing loss
Is it possible to radiate a Schwannoma tumor in the C2 spine location? (Question from Karen Clampett): The gamma knife can treat tumors in the brain and spinal cord to an inferior spine level of only C1
Do the studies show any difference in hearing preservation in Gamma vs Proton Beam? (Question from Jon Kantor): There are no studies that directly make that comparison over time but there is much hype about fractionated proton data and little objective outcome data to show long-term hearing results. Since proton radiation will also radiate the cochlea at the same dose as the tumor there is little reason to think it would improve results.
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