Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

Kapoor, Sumit; Batra, Sachin; Carson, Kathryn A.; Shuck, John; Kharkar, Siddharth; Gandhi, Rahul; Jackson, Juan; Wemmer, Jan; Terezakis, Stephanie A.; Shokek, Ori; Kleinberg, Lawrence; Rigamonti, Daniele

doi:10.1016/j.ijrobp.2010.06.006

Cited by 52 publications

(29 citation statements)

References 28 publications

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“…Kapoor et al 20 published outcomes after fractionated SRT from Johns Hopkins Hospital in 496 patients, of whom 385 had follow-up. Radiation was administered in five 5-Gy fractions or ten 3-Gy fractions.…”

Section: Stereotactic Radiation Therapy: Clinical Resultsmentioning

confidence: 99%

The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?

Kondziolka

Mousavi

Kano

et al. 2012

FOC

132

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Object Management recommendations for patients with smaller-volume or newly diagnosed vestibular schwannomas (< 4 cm3) need to be based on an understanding of the anticipated natural history of the tumor and the side effects it produces. The natural history can then be compared with the risks and benefits of therapeutic intervention using a minimally invasive strategy such as stereotactic radiosurgery (SRS). Methods The authors reviewed the emerging literature stemming from recent recommendations to “wait and scan” (observation) and compared this strategy with published outcomes after early intervention using SRS or results from matched cohort studies of resection and SRS. Results Various retrospective studies indicate that vestibular schwannomas grow at a rate of 0–3.9 mm per year and double in volume between 1.65 and 4.4 years. Stereotactic radiosurgery arrests growth in up to 98% of patients when studied at intervals of 10–15 years. Most patients who select “wait and scan” note gradually decreasing hearing function leading to the loss of useful hearing by 5 years. In contrast, current studies indicate that 3–5 years after Gamma Knife surgery, 61%–80% of patients maintain useful hearing (speech discrimination score > 50%, pure tone average < 50). Conclusions Based on published data on both volume and hearing preservation for both strategies, the authors devised a management recommendation for patients with small vestibular schwannomas. When resection is not chosen by the patient, the authors believe that early SRS intervention, in contrast to observation, results in long-term tumor control and improved rates of hearing preservation.

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Section: Stereotactic Radiation Therapy: Clinical Resultsmentioning

confidence: 99%

The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?

Kondziolka

Mousavi

Kano

et al. 2012

FOC

132

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“…One patient (5%) had treatment failure probably because of tumor progression by increased tumor size or radiation-induced tumor edema [30]. However, neither salvage radiotherapy nor microsurgery was required since the tumor volume at baseline was small and no additional neurological deficit was noted.…”

Section: Discussionmentioning

confidence: 99%

A Proposed Method to Comprehensively Define Outcomes in Acoustic Tumor Patients Undergoing CyberKnife Management

Lin¹,

Chen

Tseng

et al. 2013

Stereotact Funct Neurosurg

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Background: Vestibular assessment in patients with acoustic tumor (so-called vestibular schwannoma, VS) via ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) tests are not often discussed in the neurosurgical literature. Objectives: This study conducted physiological and morphological assessments for VS patients before and after CyberKnife radiosurgery. Methods: Twenty patients with unilateral VS underwent a battery of tests comprising facial nerve function test, audiometry, and caloric, oVEMP and cVEMP tests before and 2 years after CyberKnife treatment at a mean dosage of 18 Gy in 3 fractions. Results: The abnormal percentages of caloric, oVEMP and cVEMP tests did not significantly differ before and after Cyberknife treatment, indicating that preservation of the superior and inferior vestibular nerves can be achieved after radiosurgery. Median tumor volumes, 1.49 cm³ before treatment versus 0.97 cm³ at 2 years after treatment, differed significantly. Conclusions: The use of oVEMP and cVEMP tests in VS patients before stereotactic radiosurgery may help to evaluate the tumor origin from the superior or inferior vestibular nerve. It takes a short time and costs less, and it would be practical to make this a routine examination in VS patients having stereotactic radiosurgery.

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“…GammaKnife is the gold-standard RS system [8,9]. In the last few decades, LA-based RS systems such as BrainLAB have been used [24]. The LA-based RS system (BrainLAB) uses X-rays, a single isocentre, micro-multileaf collimators (MLCs) and forward planning, and is a more patient-friendly treatment approach [24].…”

Section: Discussionmentioning

confidence: 99%

“…In the last few decades, LA-based RS systems such as BrainLAB have been used [24]. The LA-based RS system (BrainLAB) uses X-rays, a single isocentre, micro-multileaf collimators (MLCs) and forward planning, and is a more patient-friendly treatment approach [24]. Fractionated RS is also possible in larger tumours with use of a relocatable frame.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric comparison of Linac-based (BrainLAB®) and robotic radiosurgery (CyberKnife®) stereotactic system plans for acoustic schwannoma

Dutta¹,

Subramanian²,

Murli³

et al. 2011

J Neurooncol

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A dosimetric comparison of linear accelerator (LA)-based (BrainLAB) and robotic radiosurgery (RS) (CyberKnife) systems for acoustic schwannoma (Acoustic neuroma, AN) was carried out. Seven patients with radiologically confirmed unilateral AN were planned with both an LA-based (BrainLAB) and robotic RS (CyberKnife) system using the same computed tomography (CT) dataset and contours. Gross tumour volume (GTV) was contoured on post-contrast magnetic resonance imaging (MRI) scan [planning target volume (PTV) margin 2 mm]. Planning and calculation were done with appropriate calculation algorithms. The prescribed isodose in both systems was considered adequate to cover at least 95% of the contoured target. Plan evaluations were done by examining the target coverage by the prescribed isodose line, and high- and low-dose volumes. Isodose plans and dose volume histograms generated by the two systems were compared. There was no statistically significant difference between the contoured volumes between the systems. Tumour volumes ranged from 380 to 3,100 mm(3). Dose prescription was 13-15 Gy in single fraction (median prescribed isodose 85%). There were no significant differences in conformity index (CI) (0.53 versus 0.58; P = 0.225), maximum brainstem dose (4.9 versus 4.7 Gy; P = 0.935), 2.5-Gy volume (39.9 versus 52.3 cc; P = 0.238) or 5-Gy volume (11.8 versus 16.8 cc; P = 0.129) between BrainLAB and CyberKnife system plans. There were statistically significant differences in organs at risk (OAR) doses, such as mean cochlear dose (6.9 versus 5.4 Gy; P = 0.001), mean mesial temporal dose (2.6 versus 1.7 Gy; P = 0.07) and high-dose (10 Gy) volume (3.2 versus 5.2 cc; P = 0.017). AN patients planned with the CyberKnife system had superior OAR (cochlea and mesial temporal lobe) sparing compared with those planned with the Linac-based system. Further evaluation of these findings in prospective studies with clinical correlation will provide actual clinical benefit from the dosimetric superiority of CyberKnife.

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Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

Cited by 52 publications

References 28 publications

The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?

The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?

A Proposed Method to Comprehensively Define Outcomes in Acoustic Tumor Patients Undergoing CyberKnife Management

Dosimetric comparison of Linac-based (BrainLAB®) and robotic radiosurgery (CyberKnife®) stereotactic system plans for acoustic schwannoma

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