As we found to our sorrow, Dr. Lederman is so committed to selling patients on radiation treatments as to be starkly dishonest. He assured us that there would be no side effects to the treatments, that Val would go home and live a normal life, and that the tumor would die and all problems with it would be over after his treatment.

As Val's symptoms grew worse during 2004, he was kept abreast of developments and supplied with copies of the MRI scans. He repeatedly and continually stated, despite the clear evidence of the scans, that there was no swelling of the tumor and radiation would not cause a tumor to swell. Nor were we the first to believe his false promises. There is at least one other story in the AN Archive of another patient treated by Dr. Lederman who had severe swelling afterward. This and Val's outcome obviously puts a dent in his "100% success rate" with large tumors.

Post-radiation swelling was one area where I clearly had not done sufficient research ahead of time, and... while we weren't quite desperate, we badly desired some good news at that time and wanted to believe him. My later research*, as well as the professional opinions of several doctors, has shown that, indeed tumors and brain tissue do swell in response to radiation treatment/damage, sometimes to 2 or 3 times their diameter at the time of treatment. If an AN is 1 or 1½ cm. in diameter, such swelling is surviveable; starting at 4 cm., it may not be, and in Val's case was not.

Mayo Clinic had refused Val as a patient due to their single-shot technique, saying that enough radiation to kill the tumor would kill her first, so any discussion of post-radiation swelling was a moot point and did not occur.

Dr Lederman has departed SIUH and set up a new facility at the Cabrini medical centre in Manhattan. As most of the key staff went with him, I believe that SIUH no longer offers Fractionated Stereotactic Radiation for Acoustic Neuromas at this time. Because of his obstinate refusal to inform us and others of the true risks of radiosurgery, or to even admit there was any swelling even in the face of the clear evidence on the MRI scans, I will no longer link to him or the institution where he operates. Those who are interested in his practice will have to find the links on their own.

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Radiation therapy delivers ionizing radiation to a tumor. This damages the DNA in the tumor cells and stops them from reproducing and eventually kills them. The obvious question, asked by many, is whether or not radiation also affects the normal cells of the brain. It does. But the normal cells of the skin and brain are able to quickly repair any damage. Tumor cells cannot repair the damage caused by radiation. That's why radiation works. Nevertheless, a radiation oncologist must give the normal cells a rest to recover. Thus, a course of radiation is given in fractions: small doses given each day (or every other or every third or fouth day) over a period of a few weeks. This gives the scalp and brain a day or two of rest before resuming treatment

There is a tumor size limitation for radiosurgery. Tumors larger than 1 inch (2.5cm) in diameter are probably not appropriate for radiosurgery for two important reasons: First, tumors larger than this must be treated with two or more "shots" and this diffuses the radiation dose so that the surrounding brain gets radiated - not in a fractionated way - but in a single session. This can potentially damage the surrounding brain tissue. Second, radiosurgery turns a live tumor into a dead tumor. The dead tissue must then be carted away from the brain by an inflammatory reaction. The bigger the mass of dead tissue the greater the inflammation which can make the patient sicker and dependent on high doses of steroids in attempts to keep the swelling under control. Sometimes patients require open surgery to remove this mass of dead tissue because the mass of the dead tumor plus the mass of the surrounding edema (swelling) is causing an elevation of intracranial pressure and/or neurologic deficit.

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Both of those things happened with Valerie - that is: damage to surrounding brain tissue which itself then swelled, and the inflamatory reaction to the dead and dying tumor cells. Since the tumor was so large to begin with it severely compressed the brainstem and upper spinal cord, and impacted many cranial nerves. (For a brief discussion of cranial nerves go to this page.)  However, the medical recomendations were against an emergency second surgery in an irradiated field because of the extremely high risk of damage to now sensitive and fragile brain cells and the resultant probable severe or catastrophic consequences, and the extremely poor quality of life even if the surgery was "successful".

http://www.braintumorfoundation.org/tumors/metastatic.htm
http://www.radiologyinfo.org/content/therapy/thera-brain.htm#side_effects
http://www.reutershealth.com/wellconnected/doc89.html
http://cancer.duke.edu/btc/ReadingRoom/Thinking.asp
http://www.vh.org/adult/patient/neurosurgery/faq/02brainspinaltumors.html
http://www.emoryhealthcare.org/HealthGate/32608.html
http://kidshealth.org/parent/system/surgical/brain_tumors_p2.html
http://www.rmg.md/patients/SE-CNS.htm