Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 gy

Flickinger, John C.; Kondziolka, Douglas; Niranjan, Ajay; Maitz, Ann; Voynov, George; Lunsford, L. Dade

doi:10.1016/j.ijrobp.2004.02.019

Cited by 215 publications

(73 citation statements)

References 18 publications

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“…This finding has been noted in surgical salvage after failed irradiation [82,83]. Several recent studies have demonstrated that low dose radiosurgery has a favorable efficacy/toxicity ratio as compared to higher doses [4,23,40,44,48,57,61,84]. In our analysis patients treated with lower dose Gamma Knife radiosurgery (\13 Gy) had superior facial nerve preservation rates [\13 Gy = 98.5% vs. [ 13 Gy = 94.7%, P \ 0.0001 ( Fig.…”

Section: Discussionsupporting

confidence: 76%

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

et al. 2009

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Objective Facial nerve preservation is a critical measure of clinical outcome after vestibular schwannoma treatment. Gamma Knife radiosurgery has evolved into a practical treatment modality for vestibular schwannoma patients, with several reported series from a variety of centers. In this study, we report the results of an objective analysis of reported facial nerve outcomes after the treatment of vestibular schwannomas with Gamma Knife radiosurgery. Materials and methods A Boolean Pub Med search of the English language literature revealed a total of 23 published studies reporting assessable and quantifiable outcome data regarding facial nerve function in 2,204 patients who were treated with Gamma Knife radiosurgery for vestibular schwannoma. Inclusion criteria for articles were: (1) Facial nerve preservation rates were reported specifically for vestibular schwannoma, (2) Facial nerve functional outcome was reported using the House-Brackmann classification (HBC) for facial nerve function, (3) Tumor size was documented, and (4) Gamma Knife radiosurgery was the only radiosurgical modality used in the report. The data were then aggregated and analyzed based on radiation doses delivered, tumor volume, and patient age. Results An overall facial nerve preservation rate of 96.2% was found after Gamma Knife radiosurgery for vestibular schwannoma in our analysis. Patients receiving less than or equal to 13 Gy of radiation at the marginal dose had a better facial nerve preservation rate than those who received higher doses (B13 Gy = 98.5% vs. [13 Gy = 94.7%, P \ 0.0001). Patients with a tumor volume less than or equal to 1.5 cm 3 also had a greater facial nerve preservation rate than patients with tumors greater than 1.5 cm 3 (B1.5 cm 3 99.5% vs. [1.5 cm 3 95.5%, P \ 0.0001). Superior facial nerve preservation was also noted in patients younger than or equal to 60 years of age (96.8 vs. 89.4%, P \ 0.0001). The average reported follow up duration in this systematic review was 54.1 ± 31.3 months. Conclusion Our analysis of case series data aggregated from multiple centers suggests that a facial nerve preservation rate of 96.2% can be expected after Gamma knife radiosurgery for vestibular schwannoma. Younger patients with smaller tumors less than 1.5 cm 3 and treated with lower doses of radiation less than 13 Gy will likely have better facial nerve preservation rates after Gamma Knife radiosurgery for vestibular schwannoma.

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Section: Discussionsupporting

confidence: 76%

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

et al. 2009

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“…Some studies define treatment failure as the requirement for microsurgical tumor resection and do not mention whether the need for a secondary GKRS is considered a treatment failure. 3,4 Other studies have defined tumor control as the absence of radiologically identified progression. 15,16,28 Two studies counted cases in which patients underwent shunting procedures for hydrocephalus as treatment failures.…”

Section: Definitions Of Treatment Failure and Complications Are Not Umentioning

confidence: 99%

Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands

Klijn

Verheul

Beute

et al. 2016

JNS

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OBJECT The authors of this study sought to assess tumor control and complication rates in a large cohort of patients who underwent Gamma Knife radiosurgery (GKRS) for vestibular schwannoma (VS) and to identify predictors of tumor control. METHODS The records of 420 patients treated with GKRS for VS with a median marginal dose of 11 Gy were retrospectively analyzed. Patients with neurofibromatosis Type 2 or who had undergone treatment for VS previously were excluded. The authors assessed tumor control and complication rates with chart review and used the Cox proportional hazards model to identify predictors of tumor control. Preservation of serviceable hearing, defined as Gardner-Robertson Class I–II, was evaluated in a subgroup of 71 patients with serviceable hearing at baseline and with available follow-up audiograms. RESULTS The median VS tumor volume was 1.4 cm3, and the median length of follow-up was 5.1 years. Actuarial 5-and 10-year tumor control rates were 91.3% and 84.8%, respectively. Only tumor volume was a statistically significant predictor of tumor control rate. The tumor control rate decreased from 94.1% for tumors smaller than 0.5 cm3 to 80.7% for tumors larger than 6 cm3. Thirteen patients (3.1%) had new or increased permanent trigeminal nerve neuropathy, 4 (1.0%) had new or increased permanent facial weakness, and 5 (1.2%) exhibited new or increased hydrocephalus requiring a shunting procedure. Actuarial 3-year and 5-year hearing preservation rates were 65% and 42%, respectively. CONCLUSIONS The 5-year actuarial tumor control rate of 91.3% in this cohort of patients with VS compared slightly unfavorably with the rates reported in other large studies, but the complication and hearing preservation rates in this study were similar to those reported previously. Various factors may contribute to the observed differences in reported outcomes. These factors include variations in treatment indication and in the definition of treatment failure, as well as a lack of standardization of terminology and of evaluation of complications. Last, differences in dosimetric variables may also be an explanatory factor.

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“…5 Patients underwent application of a model G Leksell stereotactic frame under local anesthesia. After attaching an imaging-compatible fiducial system to the frame, we performed either high-resolution CT or MRI in all patients.…”

Section: Radiosurgery Techniquementioning

confidence: 99%

Stereotactic radiosurgery for cerebellopontine angle meningiomas

Park

Kano

Niranjan

et al. 2014

JNS

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Object To assess the long-term outcomes of stereotactic radiosurgery (SRS) for cerebellopontine angle (CPA) meningiomas, the authors retrospectively reviewed data from a 20-year experience. They evaluated progression-free survival as well as improvement, stabilization, or deterioration in clinical symptoms. Methods Seventy-four patients with CPA meningiomas underwent SRS involving various Gamma Knife technologies between 1990 and 2010. The most common presenting symptoms were dizziness or disequilibrium, hearing loss, facial sensory dysfunction, and headache. The median tumor volume was 3.0 cm3 (range 0.3–17.1 cm3), and the median radiation dose to the tumor margin was 13 Gy (range 11–16 Gy). The median follow-up period was 40 months (range 4–147 months). Results At last imaging follow-up, the tumor volume had decreased in 46 patients (62%), remained stable in 26 patients (35%), and increased in 2 patients (3%). The progression-free survival after SRS was 98% at 1 year, 98% at 3 years, and 95% at 5 years. At the last clinical follow-up, 23 patients (31%) showed neurological improvement, 43 patients (58%) showed no change in symptoms or signs, and 8 patients (11%) had worsening symptoms or signs. The neurological improvement rate after SRS was 16% at 1 year, 31% at 3 years, and 40% at 5 years. The post-SRS deterioration rate was 5% at 1 year, 10% at 3 years, and 16% at 5 years. A multivariate analysis demonstrated that trigeminal neuralgia was the symptom most likely to worsen after SRS (HR 0.08, 95% CI 0.02–0.31; p = 0.001). Asymptomatic peritumoral edema occurred in 4 patients (5%) after SRS, and symptomatic adverse radiation effects developed in 7 patients (9%). Conclusions Stereotactic radiosurgery for CPA meningiomas provided a high tumor control rate and relatively low risk of ARE. Tumor compression of the trigeminal nerve by a CPA meningioma resulted in an increased rate of facial pain worsening in this patient experience.

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Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 gy

Cited by 215 publications

References 18 publications

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands

Stereotactic radiosurgery for cerebellopontine angle meningiomas

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