Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan

Abstract

OBJECTIVE This study aimed to explore the efficacy and safety of stereotactic radiosurgery in patients with jugular foramen schwannomas (JFSs). METHODS This study was a multiinstitutional retrospective analysis of 117 patients with JFSs who were treated with Gamma Knife surgery (GKS) at 18 medical centers of the Japan Leksell Gamma Knife Society. The median age of the patients was 53 years. Fifty-six patients underwent GKS as their initial treatment, while 61 patients had previously undergone resection. At the time of GKS, 46 patients (39%) had hoarseness, 45 (38%) had hearing disturbances, and 43 (36%) had swallowing disturbances. Eighty-five tumors (73%) were solid, and 32 (27%) had cystic components. The median tumor volume was 4.9 cm, and the median prescription dose administered to the tumor margin was 12 Gy. Five patients were treated with fractionated GKS and maximum and marginal doses of 42 and 21 Gy, respectively, using a 3-fraction schedule. RESULTS The median follow-up period was 52 months. The last follow-up images showed partial remission in 62 patients (53%), stable tumors in 42 patients (36%), and tumor progression in 13 patients (11%). The actuarial 3- and 5-year progression-free survival (PFS) rates were 91% and 89%, respectively. The multivariate analysis showed that pre-GKS brainstem edema and dumbbell-shaped tumors significantly affected PFS. During the follow-up period, 20 patients (17%) developed some degree of symptomatic deterioration. This condition was transient in 12 (10%) of these patients and persistent in 8 patients (7%). The cause of the persistent deterioration was tumor progression in 4 patients (3%) and adverse radiation effects in 4 patients (3%), including 2 patients with hearing deterioration, 1 patient with swallowing disturbance, and 1 patient with hearing deterioration and hypoglossal nerve palsy. However, the preexisting hoarseness and swallowing disturbances improved in 66% and 63% of the patients, respectively. CONCLUSIONS GKS resulted in good tumor control in patients with either primary or residual JFSs. Although some patients experienced some degree of symptomatic deterioration after treatment, persistent adverse radiation effects were seen in only 3% of the entire series at the last follow-up. Lower cranial nerve deficits were extremely rare adverse radiation effects, and preexisting hoarseness and swallowing disturbances improved in two-thirds of patients. These results indicated that GKS was a safe and reasonable alternative to surgical resection in selected patients with JFSs.

Maximum diameter versus volumetric assessment for the response evaluation of vestibular schwannomas receiving stereotactic radiotherapy

“…4 ). The local control rates in this study were lower than those in other studies (about 90%) [ 4 - 6 ]. There are several possible explanations.…”

“…Because of the infrequent occurrence, most studies are retrospective, and their management has several options including observation, surgical resection, or radiotherapy (RT). RT can be relevant due to its non-invasiveness, broad indications, and high control rates of about 90% [ 4 - 6 ].…”

Trends in the Management of Non-Vestibular Skull Base and Intracranial Schwannomas

“…The satisfactory clinical results obtained support that an appropriate strategy in the management of some LCNS is surgical resection to reduce tumor size followed by SRS in situations where GTR would likely cause significant morbidity. [78][79][80][81] We believe that this alternative is potentially safe and effective and should be considered.…”

Toxicity of Gamma Knife Radiosurgery May Be Greater in Patients with Lower Cranial Nerve Schwannomas

“…The large limitation to our study is the small number of patients in each group-particularly the schwannoma group. A larger multi-institutional retrospective review in Japan 18 evaluated 117 patients with jugular schwannoma treated with GK-SRS. They reported 5-year progression-free survival of 89% and persistent newly developed cranial nerve deficit of 3%.…”