Cystic Vestibular Schwannomas Respond Best to Radiosurgery

Bowden, Gregory; Cavaleri, Jonathon; Monaco, Edward A.; Niranjan, Ajay; Flíckinger, John C.; Lunsford, L. Dade

doi:10.1093/neuros/nyx027

Cited by 50 publications

(27 citation statements)

References 21 publications

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“…Cystic benign tumors have been initially considered less responsive to SRS. Nevertheless, this myth has been recently invalidated [4]. In case of tumor progression, further SRS versus microsurgical resection, depending on the volume, remain viable options.…”

Section: Discussionmentioning

confidence: 99%

Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Peciu-Florianu¹,

Régis²,

Levivier

et al. 2020

Neurosurg Rev

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Trigeminal nerve schwannomas (TS) are uncommon intracranial tumors, frequently presenting with debilitating trigeminal and/or oculomotor nerve dysfunction. While surgical resection has been described, its morbidity and mortality rates are non-negligible. Stereotactic radiosurgery (SRS) has emerged with variable results as a valuable alternative. Here, we aimed at reviewing the medical literature on TS treated with SRS so as to investigate rates of tumor control and symptomatic improvement. We reviewed manuscripts published between January 1990 and December 2019 on PubMed. Tumor control and symptomatic improvement rates were evaluated with separate meta-analyses. This meta-analysis included 18 studies comprising a total of 564 patients. Among them, only one reported the outcomes of linear accelerators (Linac), while the others of GK. Tumor control rates after SRS were 92.3% (range 90.1–94.5; p < 0.001), and tumor decrease rates were 62.7% (range 54.3–71, p < 0.001). Tumor progression rates were 9.4% (range 6.8–11.9, p < 0.001). Clinical improvement rates of trigeminal neuralgia were 63.5% (52.9–74.1, p < 0.001) and of oculomotor nerves were 48.2% (range 36–60.5, p < 0.001). Clinical worsening rate was 10.7% (range 7.6–13.8, p < 0.001). Stereotactic radiosurgery for TS is associated with high tumor control rates and favorable clinical outcomes, especially for trigeminal neuralgia and oculomotor nerves. However, patients should be correctly advised about the risk of tumor progression and potential clinical worsening. Future clinical studies should focus on standard reporting of clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Peciu-Florianu¹,

Régis²,

Levivier

et al. 2020

Neurosurg Rev

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“…Such discrepancies might be due to various reasons. First, definitions of successful tumor control differed, with some studies using “tumor control rate”, where a tumor is considered “controlled” if the patient requires no further surgical or radiosurgical intervention after initial SRS, regardless of any increase in tumor size [30,31], while others used PFR [17,20,23,29]. The present study used PFR, as a more sensitive measure for assessing tumor response to SRS.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Stereotactic Radiosurgery for Vestibular Schwannoma Associated with Neurofibromatosis Type 2 in Comparison to Sporadic Schwannoma

Shinya

Hasegawa

Shin

et al. 2019

Cancers

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The efficacy of radiosurgery for neurofibromatosis type 2 (NF2)-associated vestibular schwannoma (VS) remains debatable. We retrospectively analyzed radiosurgical outcomes for NF2-associated VS compared to sporadic VS using our database of 422 consecutive VS patients. Twenty-five patients with 30 NF2-associated VSs with a mean follow-up of 121 months were identified. NF2-associated VSs exhibited excellent tumor control (10-year cumulative rate, 92% vs. 92% in sporadic VSs; p = 0.945) and worse overall survival (73% vs. 97%; p = 0.005), mainly due to tumor progression other than the treated VSs. The presence of NF2 was not associated with failed tumor control via multivariate Cox proportional hazard analyses. No difference in radiation-induced adverse events (RAEs) was confirmed between cohorts, and prescription dose (hazard ratio 8.30, 95% confidence interval 3.19–21.62, p < 0.001) was confirmed as a risk for cranial nerve injuries via multivariate analysis. Further analysis after propensity score matching using age, volume, and sex as covariates showed that NF2-associated VSs exhibited excellent local control (100% vs. 93%; p = 0.240) and worse overall survival (67% vs. 100%; p = 0.002) with no significant difference in RAEs. Excellent long-term tumor control and minimal invasiveness may make radiosurgery a favorable therapeutic option for NF2 patients with small to medium VS, preferably with non-functional hearing or deafness in combination with postoperative tumor growth or progressive non-operated tumors, or with functional hearing by patients’ wish.

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“…GKSRS has been utilized in the treatment of VS for over half a century, and in the modern era provides high levels of long-term local control with improving hearing and CN preservation 10 . Local control continues to be defined as the need for a second intervention as opposed to radiologic changes, 6,15 with rates of PFS ranging between 92-100%. 13 Overall local control hovers around 95% 15 on systematic review with mean follow-ups of approximately 8 years in tumors <2cm 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Maximum dose was defined as dose to <0.01cc of a given structure. Tumor volume was also calculated post-hoc utilizing an ellipsoid formula [(π/6)XD AP XD TRV XD CC ] in cubic millimeters (mm 3 ) as previously described 6 . Tumor measurements were performed prior to determining tumor outcome or toxicity per patient to avoid measurement bias.…”

Section: Treatmentmentioning

confidence: 99%

Tufts Medical Center Experience With Long-Term Follow-Up of Vestibular Schwannoma Treated With Gamma Knife Stereotactic Radiosurgery: Novel Finding of Delayed Pseudoprogression

Wage

Mignano

2021

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Cystic Vestibular Schwannomas Respond Best to Radiosurgery

Abstract: SRS provided VS tumor control in >95% of patients, regardless of radiographic characteristics. Tumor volume regression was most evident in patients with cystic tumors.

Cited by 50 publications

References 21 publications

Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

Long-Term Outcomes of Stereotactic Radiosurgery for Vestibular Schwannoma Associated with Neurofibromatosis Type 2 in Comparison to Sporadic Schwannoma

Tufts Medical Center Experience With Long-Term Follow-Up of Vestibular Schwannoma Treated With Gamma Knife Stereotactic Radiosurgery: Novel Finding of Delayed Pseudoprogression

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