Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): Comparison between cystic-type and solid-type VS

Shirato, Hiroki; Sakamoto, Tsukasa; Takeichi, Nobuhiko; Aoyama, Hidefumi; Suzuki, Kazushige; Kagei, Kenji; Nishioka, Takashi; Fukuda, Satoshi; Sawamura, Yutaka; Miyasaka, Kazuo

doi:10.1016/s0360-3016(00)00731-8

Cited by 82 publications

(45 citation statements)

References 23 publications

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“…In recent series with long-term follow-up, local control rates of well over 90% were reported with this treatment. [9][10][11][12][13][14][17][18][19][20][21] In the current series, we found that in as many as 7 of 45 patients (15.6%), the tumor was larger at last follow-up scanning than it was before treatment. In contrast to our current series, most of the studies used maximal axial diameters as a parameter to assess local control rates.…”

Section: Tumor Controlmentioning

confidence: 74%

“…[16][17][18] Because local tumor control is always defined at a certain time interval after treatment, some authors published tumor size at different time points after radiosurgery, based on tumor diameter. [19][20][21] The few studies that are available on these tumor-size time trends based on actual tumor-volume measurements have follow-up periods that are generally too short to assess long-term tumor-size time trends. 17,18 To describe actual tumor-volume changes in VS treated with radiosurgery and subsequently to propose a post-treatment follow-up MR imaging program, we performed a retrospective study in which we measured and analyzed long-term tumor-volume changes based on digital tumor contour drawings on T1-weighted gadolinium-enhanced high-resolution 3D MR imaging in patients treated with radiosurgery for VS.…”

mentioning

confidence: 99%

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Tumor-Volume Changes after Radiosurgery for Vestibular Schwannoma: Implications for Follow-Up MR Imaging Protocol

Meijer¹,

Weijmans²,

Knol³

et al. 2008

AJNR Am J Neuroradiol

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Section: Tumor Controlmentioning

confidence: 74%

mentioning

confidence: 99%

Tumor-Volume Changes after Radiosurgery for Vestibular Schwannoma: Implications for Follow-Up MR Imaging Protocol

Meijer¹,

Weijmans²,

Knol³

et al. 2008

AJNR Am J Neuroradiol

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“…Enlargement of the cyst following radiation, even after several years, has been noted to occur, and in some cases emergent surgical decompression may be required to avoid permanent cranial neuropathy. 22,35,74,92 Results of surgery, however, are also known to be unfavorable for cystic VS, and surgical treatment is associated with higher rates of morbidity. 10,17,33,94,107 At this point, the data in support of SRS or radiation therapy for treatment of cystic VS are too scant to even consider these treatments as reasonable alternatives to surgery.…”

Section: Sudden Hearing Loss In Small Vsmentioning

confidence: 99%

“…22,76 They are characterized by rapid growth and therefore may result in a shorter duration of symptoms related to the vestibulocochlear and facial nerves and may also be seen in certain cases of small VS. Management of small VS with a cystic component is conten tious. 10,16,17,22,33,74,92,94,107 There is a severe lack of comparative data (even Level 3 or 4 evidence) to support the superiority of surgery or SRS or radiotherapy as a treatment strategy. Treatment of these lesions by means of either microsurgery or SRS is challenging and fraught with risks.…”

Section: Sudden Hearing Loss In Small Vsmentioning

confidence: 99%

“…10,17,33,94,107 At this point, the data in support of SRS or radiation therapy for treatment of cystic VS are too scant to even consider these treatments as reasonable alternatives to surgery. 92 That being said, SRS and radiotherapy as well as surgery would have to be evaluated with better study designs and longer follow-up.…”

Section: Sudden Hearing Loss In Small Vsmentioning

confidence: 99%

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An update on unilateral sporadic small vestibular schwannoma

Thakur¹,

Banerjee

Khan³

et al. 2012

FOC

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Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.

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Prediction of transient tumor enlargement using MRI tumor texture after radiosurgery on vestibular schwannoma

et al. 2020

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Purpose: Vestibular schwannomas (VSs) are uncommon benign brain tumors, generally treated using Gamma Knife radiosurgery (GKRS). However, due to the possible adverse effect of transient tumor enlargement (TTE), large VS tumors are often surgically removed instead of treated radiosurgically. Since microsurgery is highly invasive and results in a significant increased risk of complications, GKRS is generally preferred. Therefore, prediction of TTE for large VS tumors can improve overall VS treatment and enable physicians to select the most optimal treatment strategy on an individual basis. Currently, there are no clinical factors known to be predictive for TTE. In this research, we aim at predicting TTE following GKRS using texture features extracted from MRI scans. Methods: We analyzed clinical data of patients with VSs treated at our Gamma Knife center. The data was collected prospectively and included patient-and treatment-related characteristics and MRI scans obtained at day of treatment and at follow-up visits, 6, 12, 24 and 36 months after treatment. The correlations of the patient-and treatment-related characteristics to TTE were investigated using statistical tests. From the treatment scans, we extracted the following MRI image features: first-order statistics, Minkowski functionals (MFs), and three-dimensional gray-level co-occurrence matrices (GLCMs). These features were applied in a machine learning environment for classification of TTE, using support vector machines. Results: In a clinical data set, containing 61 patients presenting obvious non-TTE and 38 patients presenting obvious TTE, we determined that patient-and treatment-related characteristics do not show any correlation to TTE. Furthermore, first-order statistical MRI features and MFs did not significantly show prognostic values using support vector machine classification. However, utilizing a set of 4 GLCM features, we achieved a sensitivity of 0.82 and a specificity of 0.69, showing their prognostic value of TTE. Moreover, these results increased for larger tumor volumes obtaining a sensitivity of 0.77 and a specificity of 0.89 for tumors larger than 6 cm 3 . Conclusions: The results found in this research clearly show that MRI tumor texture provides information that can be employed for predicting TTE. This can form a basis for individual VS treatment selection, further improving overall treatment results. Particularly in patients with large VSs, where the phenomenon of TTE is most relevant and our predictive model performs best, these findings can be implemented in a clinical workflow such that for each patient, the most optimal treatment strategy can be determined.

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Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): Comparison between cystic-type and solid-type VS

Cited by 82 publications

References 23 publications

Tumor-Volume Changes after Radiosurgery for Vestibular Schwannoma: Implications for Follow-Up MR Imaging Protocol

Tumor-Volume Changes after Radiosurgery for Vestibular Schwannoma: Implications for Follow-Up MR Imaging Protocol

An update on unilateral sporadic small vestibular schwannoma

Prediction of transient tumor enlargement using MRI tumor texture after radiosurgery on vestibular schwannoma

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