Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery

Eichkorn, Tanja; Regnery, Sebastian; Held, T.; Kronsteiner, Dorothea; Hörner-Rieber, Juliane; Shafie, Rami A El; Herfarth, Klaus; Debus, Jürgen; König, Laila

doi:10.3389/fonc.2021.772831

Cited by 5 publications

(12 citation statements)

References 38 publications

(46 reference statements)

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“…Some preliminary experiences have shed light on the possible role of proton beam radiotherapy which, using heavy particles, may overcome the intrinsic radioresistance of vagal schwannomas and allow for extremely high local control and favorable nerve functional protections rates [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review

et al. 2023

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Background and Objectives: Clinical management of vagal schwannoma is a real diagnostic and therapeutic challenge because the medical history and clinical examination are often non-specific and vagal nerve injury following surgical resection still represents an unsolved problem. The aim of this paper is to provide a case series along with a diagnostic and therapeutic algorithm for vagal schwannoma of the head and neck, combining our experience with clinical evidence available in the literature. Materials and Methods: We retrospectively analyzed a series of patients affected by vagal schwannoma who were treated between 2000 and 2020. In addition, a review of the literature on vagal schwannoma management was conducted. Based on the cases described and the literature review, we made a diagnostic and therapeutic algorithm for the management of vagal schwannoma. Results: We were able to identify 10 patients affected by vagal schwannoma and treated between 2000 and 2020. All patients presented with a painless, mobile, slow-growing lateral neck mass with onset varying from a few months to years. The preoperative diagnostic workup included ultrasound (US) in nine cases, computed tomography (CT) with contrast in six patients and magnetic resonance imaging (MRI) of the neck in seven cases. All patients included in this study were surgically treated. Conclusions: Vagal schwannoma management represents a true challenge for clinicians and surgery is currently the most effective therapeutic strategy. A multidisciplinary approach through the collaboration of otolaryngologist with other specialists is desirable to develop a tailored treatment plan for the patient.

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Section: Discussionmentioning

confidence: 99%

Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review

et al. 2023

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“…One article identified in the initial search strategy reported treatments of multiple types of schwannomas, without separately detailing the outcomes for each one of them and was further excluded [ 8 ]. Eight studies [ 6 , 9 – 15 ] reporting 587 patients met the inclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

Proton beam radiation therapy for vestibular schwannomas-tumor control and hearing preservation rates: a systematic review and meta-analysis

Santacroce¹,

Trandafirescu²,

Levivier³

et al. 2023

Neurosurg Rev

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Objective Proton beam therapy is considered, by some authors, as having the advantage of delivering dose distributions more conformal to target compared with stereotactic radiosurgery (SRS). Here, we performed a systematic review and meta-analysis of proton beam for VSs, evaluating tumor control and cranial nerve preservation rates, particularly with regard to facial and hearing preservation. Methods We reviewed, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) articles published between 1968 and September 30, 2022. We retained 8 studies reporting 587 patients. Results Overall rate of tumor control (both stability and decrease in volume) was 95.4% (range 93.5–97.2%, p heterogeneity= 0.77, p<0.001). Overall rate of tumor progression was 4.6% (range 2.8–6.5%, p heterogeneity < 0.77, p<0.001). Overall rate of trigeminal nerve preservation (absence of numbness) was 95.6% (range 93.5–97.7%, I2 = 11.44%, p heterogeneity= 0.34, p<0.001). Overall rate of facial nerve preservation was 93.7% (range 89.6–97.7%, I2 = 76.27%, p heterogeneity<0.001, p<0.001). Overall rate of hearing preservation was 40.6% (range 29.4–51.8%, I2 = 43.36%, p heterogeneity= 0.1, p<0.001). Conclusion Proton beam therapy for VSs achieves high tumor control rates, as high as 95.4%. Facial rate preservation overall rates are 93%, which is lower compared to the most SRS series. Compared with most currently reported SRS techniques, proton beam radiation therapy for VSs does not offer an advantage for facial and hearing preservation compared to most of the currently reported SRS series.

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“…SRS and FRT with modern techniques can achieve similar results in terms of local control and hearing function, although FRT can be used when surgery is not feasible or when a patient has larger VSs (Koos grades 3–4) in close proximity to the brainstem ( 119 , 120 , 127 , 128 ).…”

Section: Vestibular Schwannomasmentioning

confidence: 99%

The role of particle radiotherapy in the treatment of skull base tumors

et al. 2023

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The skull base is an anatomically and functionally critical area surrounded by vital structures such as the brainstem, the spinal cord, blood vessels, and cranial nerves. Due to this complexity, management of skull base tumors requires a multidisciplinary approach involving a team of specialists such as neurosurgeons, otorhinolaryngologists, radiation oncologists, endocrinologists, and medical oncologists. In the case of pediatric patients, cancer management should be performed by a team of pediatric-trained specialists. Radiation therapy may be used alone or in combination with surgery to treat skull base tumors. There are two main types of radiation therapy: photon therapy and particle therapy. Particle radiotherapy uses charged particles (protons or carbon ions) that, due to their peculiar physical properties, permit precise targeting of the tumor with minimal healthy tissue exposure. These characteristics allow for minimizing the potential long-term effects of radiation exposure in terms of neurocognitive impairments, preserving quality of life, and reducing the risk of radio-induced cancer. For these reasons, in children, adolescents, and young adults, proton therapy should be an elective option when available. In radioresistant tumors such as chordomas and sarcomas and previously irradiated recurrent tumors, particle therapy permits the delivery of high biologically effective doses with low, or however acceptable, toxicity. Carbon ion therapy has peculiar and favorable radiobiological characteristics to overcome radioresistance features. In low-grade tumors, proton therapy should be considered in challenging cases due to tumor volume and involvement of critical neural structures. However, particle radiotherapy is still relatively new, and more research is needed to fully understand its effects. Additionally, the availability of particle therapy is limited as it requires specialized equipment and expertise. The purpose of this manuscript is to review the available literature regarding the role of particle radiotherapy in the treatment of skull base tumors.

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Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery

Cited by 5 publications

References 38 publications

Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review

Diagnostic and Therapeutic Strategy for Vagal Schwannoma: Case Series and Literature Review

Proton beam radiation therapy for vestibular schwannomas-tumor control and hearing preservation rates: a systematic review and meta-analysis

The role of particle radiotherapy in the treatment of skull base tumors

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