Conventionally Fractionated Stereotactic Radiotherapy for Vestibular Schwannoma: A Single Institutional Long-term Outcomes

Aoyama, Hidefumi; Takeichi, N; Onodera, Shunsuke; Taguchi, Hiroshi; Sawamura, Yutaka; Shirato, Hiroki

doi:10.1016/j.ijrobp.2010.07.062

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“…Previous studies reported transient tumor volume increase rates varying between 5-74% among patients treated with SRS [24][25][26][27][28][29][30][31] and a 48% rate among patients treated with FSRT [32]. A recent study showed that transient tumor progression after FRST can occur up to three years and is more frequent in larger tumors (> 3 cm) [33]. Some studies found a correlation between tumor enlargement and initial tumor volume after SRS [28], others did not [26,29,31].…”

Section: Discussionmentioning

confidence: 99%

“…Although many factors have been analyzed, no statistical association with hearing loss was found. Some studies have associated hearing loss and transient tumor progression [33], other studies did not report a correlation [31]. Predictors of hearing loss after SRS were significant hearing loss before SRS, tumor recurrence and the prescription isodose line, according to a recent study by Wowra et al [51].…”

Section: Discussionmentioning

confidence: 99%

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Transient Tumor Volume Increase in Vestibular Schwannomas After Radiotherapy

Hathout¹

2012

Cureus

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Background: Transient tumor progression is difficult to diagnose and is challenging for the physician. Objectives: To report and review the transient tumor progression rate and induced toxicities in patients treated for vestibular schwannomas (VS). Materials and Methods: From January 2005 to February 2010, 43 patients with VS were consecutively treated at our institution. Twenty patients (46.5%) were treated with fractionated stereotactic radiation therapy (FSRT) using a LINAC or a CyberKnife technique with doses varying between 18 and 50.4 Gy. Radiosurgery (SRS) on a conventional LINAC and on a CyberKnife were performed in 13 patients (30%) (median dose of 12 Gy). Tumor volume increase was calculated from the first tumor volume increase until tumor stability or regression. A Fisher's exact test and Mann-Whitney U test were used for statistical analysis. Results: Transient tumor volume increase occurred in 10 patients (25%) with a median time to tumor enlargement of 5.5 months (1-25 months). Prior surgical resection was significantly associated with transient tumor volume increase (Fisher exact, p=0.02). Increased rates of facial and trigeminal neuropathies were associated with transient tumor volume increase (p=0.04 and p=0.08, respectively). The pseudoprogression rate and the cranial nerve toxicity were not associated with any dosimetric factor. Conclusions: Transient tumor volume increase is frequent (25%) after radiotherapy and significantly associated with previous resection possibly due to the surgical microvascular insult. Cranial nerve toxicities are significantly correlated with, and possibly caused by, transient tumor progression.

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