Re: [MOL] Oncologist Appointment [12727] Medicine On Line

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Re: [MOL] Oncologist Appointment

My Dear Donna:  Thank you for your oncologist report.  You know this is one decision you must make on your own; as you will be the one who has to live with it and be comforatable that you made the very best descision for you.  Whatever your decision is though, we will all be here for you dear one.  Once the chemo and rads are done and they can see the size of the tumor, perhaps then the surgery, you know it even could be that when it shrinks from the treatments, it may no longer be wraped around anything and be quite easy to remove.  My understanding though is that radio---- can't remember how to spell it, isn't really surgery, they pin point the exact area that they will beam the radiation, thus less tissue damage, I just read all about it on the brain, no more sawing or holes in the skull; etc., infact there is a web site on it, let me get it for you. Here's all the info. XXoo LIL

The Lars Leksell Center for Gamma Knife Radiosurgery

Department of Neurosurgery, University of Virginia , Charlottesville
Virginia, USA

The Gamma Knife

The Gamma knife is a dedicated neurosurgical tool for performing brain surgery with as little damage to the brain and with as much function preservation as possible. It uses highly focused beams of 201 independent Cobalt 60  sources to produce its biological effects on tissues inside the intact skull. The treatment is done in a single sitting and thus has the benefits of increased biological efficacy of the radiation along with decreased hospital stay and side effects. This approach also allows the treatment of lesions that are not considered radiosensitive.

The University of Virginia Gamma Knife was commissioned in March 1989 and has treated more than 2000 patients to date under the direction of Ladislau Steiner MD, PhD, Alumni Professor of Neurosurgery and Radiosurgery. As a close associate of Professor Lars Leksell at the Karolinska Institute, Sweden, he was involved from the begining in the developement of the Gamma Knife and its clinical application. The late Professor Lars Leksell, one of the most innovative neurosurgeons of our time, as early as 1951 conceived the idea of using a single focused high dose of ionizing beams , and coined the term radiosurgery . Following extensive experimental and clinical research the first Gamma Knife was built in 1967.

Neurosurgeons at the Gamma Knife Center at the University of Virginia  in mastering both microsurgery and radiosurgery can provide advice and management for the whole range of brain disorders without bias in decision making. Specialists in neuro-radiology, endocrinology, anaesthesiology, neuro-ophthalmology, neuro-otology, radiation oncology and medical physics in the team provide comprehensive care to the patient. The center is continuously involved in development and research activity in the field.

The Gamma Knife Team

Director :
Ladislau Steiner MD, PhD
Alumni Professor of Neurosurgery and Radiology

Dheerendra Prasad MD
Assistant Professor of Neurosurgery

John A. Jane MD PhD
David. D. Weaver Professor of Neurosurgery

Neal F. Kassell MD
Professor of Neurosurgery.

Edward Laws MD, FACS
Professor of Neurosurgery and Internal Medicine.

Melita Steiner MD
Research Professor in Neurosurgery

Péter Várady MD
Lars Leksell Fellow

Jayant Misra MD
Research Fellow in Radiosurgery

György Szeifert MD PhD
Research Fellow in Radiosurgery

Wayne S Cail MD
Professor of Neuroradiology,

Maurice Lipper MD
Associate Professor of Neuroradiology

C. Douglas Phillips MD
Associate Professor of Neuroradiology

Jacques E. Dion MD FRCP(C)
Head, Interventional Radiology
Associate Professor of Radiology and Neurosurgery

Mary E. Jensen MD
Assistant Professor of Interventional Radiology and Neurosurgery

Michael O. Thorner MB, DSc, FRCP
Professor of Internal Medicine
Head, Division of Endocrinology and Metabolism

Mary Lee Vance MD
Professor of Internal Medicine
Division of Endocrinology and Metabolism

Alan D Rogol MD
Professor of Paediatrics & Pharmacology (Paediatric Endocrinology)

Edward H. Bertram, III , MD
Associate Professor of Neurology

Brian P Conway MD
Professor of Ophthalmology

Steven A Newman MD
Associate Professor of Ophthalmology & Neurological Surgery

Paul R Lambert MD
Professor of Otolarnygology (Neuro-otology)

David Stone MD
Associate Professor of Anaesthesiology and Neurosurgery

David Bogdanoff MD
Associate Professor of Anaesthesiology

Burkhardt Spiekermann MD
Assistant Professor of Anaesthesiology

William C. Constable MD
Professor of Radiation Oncology and Otolaryngology

Scott R. VandenBerg MD,PhD
Professor of Neuro-pathology and Neurological Surgery

Harold W. Berk PhD
Division of Medical Physics
Associate Professor of Radiology and Neurosurgery

Savola 'Butter' Monroe RN BSN CNOR
Clinical Manager Neurosurgery Operating Rooms

Clare Pittman RN MS
Nurse Coordinator

Marion Harding RTT
Gamma Knife Technologist

Sophie L. Yu
Administrator, Gamma Knife Center

Program Support:
Brenda Hogan
Gladys Haney
Mary Burton

Clinical / Patient related queries:
Ladislau Steiner MDPhD E-mail:
Dheerendra Prasad MD
Melita Steiner MD

Room G 512, Primary Care Center
University of Virginia, Health Sciences Center
Lee Street , Charlottesville, VA 22908

TELEPHONE: (804) - 982 - 0091/ 94/ 95/ 96/ 62

FAX:                 (804) - 982 - 0543

Administrative queries:
Sophie L Yu  E-mail:

TELEPHONE: (804) - 924 -2336

FAX:                 (804) - 977- 6279





Vascular Malformations 

Arteriovenous Malformations (AVM)  1140 
Dural Malformations  63 
Other Vascular Malformations  17 

Benign Tumors 

Meningioma  269 
Vestibular Schwannoma (Accoustic neuroma)  146 
Pituitary adenomas  155 
Craniopharyngiomas  28 
Low GradeAstrocytoma  49 

Malignant Tumors 

Malignant astrocytomas  44 
Metastatic tumors  165 
Uveal Melanoma 

Functional Disorders 

Trigeminal Neuralgia 




as of 9/10/97 


*Dr. Steiner has a personal experience of more than 3200 cases.

*Based on our prior experience with Cavernous malformations (cavernomas) we currently do not recommend the use of the Gamma Knife in their treatment, and feel that there should be a moratorium on the issue of radiosurgery in cavernomas till the cause of the higher risk for radiation related side effects in these cases has been elucidated.

Arteriovenous Malformations (AVM)

Dural Malformations

Pituitary adenomas



Accoustic neuroma

Low GradeAstrocytoma

Malignant astrocytomas

Metastatic tumors

Uveal Melanoma

Trigeminal Neuralgia


Joicy Becker-Richards wrote:

Dear Donna,

It isn't easy, is it? You are handling all of this with great strength
and presence of mind, but I know inside you must be reeling. I
appreciate your sharing with us all that is going on; it will help me to
be more focused in my prayers for you and your family. Also glad that
you're going to take some time for yourself, with your family. That's
important too.

Donna, as you consider your prognosis, don't be discouraged, my friend.
Keep in mind that there are too many folks out there that have made
liars out of their drs. Marty's Barb is one, and I have a couple in my
family. As I shared before you came online, I have an aunt who was sent
home to die in her "middle years" who finally passed on -- at 103! And a
cousin with an infant and young wife -- he, too, was written off, but
just celebrated his "baby's" graduation from college! As they say, it
isn't over till it's over.

And through the days ahead, know that we are here for you. You don't
have to be brave for us, or "up" all the time -- you can vent, complain,
whatever! We'll be there. Love, Joicy wrote:
> What a day!  I got to my appointment (finally).  When I went to check in the
> first words out of the secretary's moth was that my HMO never sent the
> referral.  The HMO set this whole thing up.  What gives?  I had to walk to a
> pay phone and call the HMO to have them fax the referral over.  Anyway....
> This is the scoop.  I liked this oncologist. He really check me over.  He is
> certain that it has not spread to brain, liver, CT scans and exam.
> He thinks this was primary but has requested a pelvic CT scan to be certain.
> That is the only test he he suggested.
> Lowdown.......No surgery (he agreed with Hopkins surgeon).  Radiation and
> chemo first thing.  Along with Taxall and something else. Starting as soon as
> next week. He said that I would have trouble swallowing towards the 4-5 week
> due to the esophagus being exposed.  In fact, in all liklihood I would not be
> able to eat solid foods for a few weeks.  It would heal itself over time.
> Then he explained chemo complications, etc... I explained to him I was looking
> into stereotactic radiosurgey.  He did not seem positive on that however, that
> was the only thing he said that I did not like.  Very small chance that tumor
> would shrink small enough to be surgically removed.  And even then a very
> short window of opportunity to remove immediately following radiation and
> chemo due to scar tissue build-up after radiation.
> Now he did not go there, but I did. What about prognosis? 1 year without
> treatment, an additional 6 months to a year with treatment.  Although he said
> some people go on to live 3-5 years.  He asked if I wanted statistics and I
> said NO! He said good because he does not believe in them.
> My 2 older children are going down to the beach to stay with my father(he
> lives there) over the wekend.  My husband and our 3 year old  will join them
> on Sunday.  We were only going to stay Sunday and come home Sunday evening.  I
> have decided to stay until Monday and maybe even Tuesday.  Although he has
> said next week.  I have decided to a) see one more oncologist b) wait to hear
> from SIUH about radiosurgery c) check out the University of Virgina d) info
> provided by others and last but not least meditate and pray on all of this.
> Then and only then do I feel I can make a positive and informed decision.
> Any information and/or guidance you may be able to offer would be most
> appreciated.
> A friend to all of you molers,
> Donna
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