Thank you so much for this @sepdvm . I’m sorry that you’ve had to go through that but amazing that you are 13 years down the line with local recurrence. I get the impression from consultants that metastasis is the main problem but again that’s amazing that you’ve been able to have them dealt with.
My ACC is very near the near blood vessel and nerves going through the foramen rotundum so they wouldn’t be able to remove this bit. Therefore the thoughts are what’s the point in removing the large part sitting below this and below the skull base if this problematic part will be left. Some surgeons have said if you debulk the tumour the smaller parts will be easier to deal with for radiotherapy. Others have said that it makes no difference - radiotherapy will deal with the large tumour in the same way it will the smaller parts. So this is the bit I don’t know! The worry is the risk of surgery given the closeness to the skull base and the risk of CSF leakage. Also someone mentioned the increased risk of metastasis with surgery if it gets in the bloodstream. In my mind if less of the tumour is there there are less cancer cells to ‘wake up’ from the radiotherapy. I didn’t realise you could sensitise the tumour before radiotherapy - ACC obviously being pretty radio resistant one too. I will look in to this. Did they know they wouldn’t be able to remove your tumour with clear margins? I tried to get a telephone appointment with Mayo clinic but they only do them in person sadly.