Brazilian Society of Otology task force – Vestibular Schwannoma ‒ evaluation and treatment

Managing vestibular schwannomas with radiosurgery and radiotherapy: AGREE II appraisal of clinical practice guidelines

“…As shown in Figure 1, the systematic literature search narrowed an initial 1475 publications to nine CPGs on the management of VSs with radiosurgery and radiotherapy. [10][11][12][13][14][15][16][17][18] Their general properties are shown in Table 2. Notably, two editions of guidelines from the International Stereotactic Radiosurgery Society (ISRS) released in 2017 and 2023 were both included given clear differences in focus.…”

“…Guidelines were relatively unified on topics relating to small (<2 cm) and recurrent VS, recommending observation and stereotactic radiosurgery (SRS) as equally valid options for the former but SRS being required for the latter. [10][11][12][13]15,17,18 Similarly, CPGs uniformly recommended use of thin-slice MRI for treatment planning and 12-13 Gy for SRS alongside no strong preference between single and fractionated doses or radiosurgical modality (i.e. gamma knife or proton beam).…”

“…gamma knife or proton beam). [10][11][12][13][14][15][16][17][18] Discrepancies arose when discussing large VS (>3 cm). The ISRS 2023 guideline uniquely recommended single-dose upfront SRS for large VS in ideal candidates while all other CPGs recommended upfront surgery followed by SRS.…”

“…The ISRS 2023 guideline uniquely recommended single-dose upfront SRS for large VS in ideal candidates while all other CPGs recommended upfront surgery followed by SRS. 12,13,16,17 Analogously, guidance on interval and duration of radiographic follow-up ranged widely. Some guidelines recommended follow-up imaging based on professional judgement, others recommended strict annual or biannual scans indefinitely and some recommended a schedule in-between both extremes.…”

“…9 Various professional societies have produced clinical practice guidelines (CPGs) in recent years to help alleviate this issue. [10][11][12][13][14][15][16][17][18] In principle, these CPGs involve a multidisciplinary group of expert authors who systematically collect and evaluate all available evidence on the topic to recommend best practices. 19 Such directed guidance could then be synthesized directly and improve radiosurgery and radiotherapy management outcomes for VS patients worldwide.…”