Long term results of primary radiosurgery for vestibular schwannomas

Johnson, Stephen A.; Kano, Hideyuki; Faramand, Andrew; Pease, Matthew; Nakamura, Aya; Hassib, Mohab; Spencer, David P.; Sisterson, Nathaniel D; Faraji, Amir H.; Arai, Yoshinori; Monaco, Edward A.; Niranjan, Ajay; Flíckinger, John C.; Lunsford, L. Dade

doi:10.1007/s11060-019-03290-0

Cited by 61 publications

(63 citation statements)

References 28 publications

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“…But neither of the latter two studies analyzed preradiosurgery changes as a predictor of postradiosurgery progression. 20 Our data are similar to Varughese et al, as we observed that preradiosurgery tumor volumes less than 0.3 cm 3 are associated with postradiosurgery enlargement. In other words, in our cohort, smaller tumors enlarge more frequently postradiosurgery than larger tumors.…”

Section: Discussionsupporting

confidence: 92%

Vestibular Schwannoma Tumor Size and Growth Rate Predict Response with Gamma Knife Stereotactic Radiosurgery

Killeen

Tolisano

Isaacson

et al. 2020

J Neurol Surg B Skull Base

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Objective The aim of this study is to determine if pretreatment growth of sporadic vestibular schwannomas (VS) predicts postradiosurgery response. Methods This study was a retrospective chart review at a tertiary referral center of patients with VS that had at least two pretreatment magnetic resonance imaging (MRI) studies at least 6 months apart and underwent Gamma Knife radiosurgery with a minimum of 14 months postradiosurgery imaging surveillance. Tumor linear measurements and volumetric segmentation were assessed before and after radiosurgery. The main outcome measure was persistent enlargement following radiosurgery, defined as 2 mm enlargement in greatest axial diameter or 20% enlargement in volume without size regression. Results Thirty-five patients met the inclusion criteria. Patients were observed for median pre- and posttreatment intervals of 29.5 and 40.6 months, respectively. Median dose to the tumor margin was 13 Gy. Postradiosurgery enlargement occurred in six (17.1%) and nine (25.7%) patients based on linear and volumetric enlargement definitions, respectively. Pseudoprogression—defined as tumor enlargement—followed by linear or volumetric regression that occurred in 34.3% of tumors, reaching a maximum size at a median time of 6.3 months (3.3–8.4) postradiosurgery. When controlling for age, gender, and radiation dose, preradiosurgery tumor volume less than 0.3 cm3 (odds ratio [OR]: 59.7, p = 0.012) and preradiosurgery tumor diameter growth rate greater than or equal to 2.5 mm/year (OR: 19.3, p = 0.045) were associated with persistent postradiosurgery tumor enlargement. Conclusion Smaller pretreatment tumor volume and greater linear tumor growth rates were associated with postradiosurgery tumor enlargement when controlling for age, gender, and radiation dose. Level of Evidence :This study indicates that the level of evidence is V.

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Section: Discussionsupporting

confidence: 92%

Vestibular Schwannoma Tumor Size and Growth Rate Predict Response with Gamma Knife Stereotactic Radiosurgery

Killeen

Tolisano

Isaacson

et al. 2020

J Neurol Surg B Skull Base

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“…The results of our systematic review and meta-analysis show that repeat SRS for VS remains safe and effective, as the results after a first SRS [17]. Here, we included 8 studies comprising 194 patients, all treated with GK as second SRS after a previously failed SRS for VS. We report overall tumor stability in 29.6% of cases, decrease in 54.4%, and further tumor progression in 16.1%.…”

Section: Discussionmentioning

confidence: 99%

Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

et al. 2021

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Vestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing from the vestibular part of the eight cranial nerves. Stereotactic radiosurgery (SRS) has now a long-term scientific track record as first intention treatment for small- to medium-sized VS. Though its success rate is very high, SRS for VS might fail to control tumor growth in some cases. However, the literature on repeat SRS after previously failed SRS remains scarce and reported in a low number of series with a limited number of cases. Here, we aimed at performing a systematic review and meta-analysis of the literature on repeat SRS for VS. Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2020 and referenced in PubMed. Tumor control and cranial nerve outcomes were evaluated with separate meta-analyses. Eight studies comprising 194 patients were included. The overall rate of patients treated in repeat SRS series as per overall series with first SRS was 2.2% (range 1.2–3.2%, p < 0.001). The mean time between first and second SRS was 50.7 months (median 51, range 44–64). The median marginal dose prescribed at first SRS was 12 Gy (range 8–24) and at second SRS was 12 Gy (range 9.8–19). After repeat SRS, tumor stability was reported in 61/194 patients, i.e., a rate of 29.6% (range 20.2–39%, I2 = 49.1%, p < 0.001). Tumor decrease was reported in 83/194 patients, i.e., a rate of 54.4% (range 33.7–75.1%, I2 = 89.1%, p < 0.001). Tumor progression was reported in 50/188 patients, i.e., a rate of 16.1% (range 2.5–29.7%, I2 = 87.1%, p = 0.02), rarely managed surgically. New trigeminal numbness was reported in 27/170 patients, i.e., a rate of 9.9% (range 1.4–18.3%, p < 0.02). New facial nerve palsy of worsened of previous was reported in 8/183 patients, i.e., a rate of 4.3% (range 1.4–7.2%, p = 0.004). Hearing loss was reported in 12/22 patients, i.e., a rate of 54.3% (range 24.8–83.8%, I2 = 70.7%, p < 0.001). Repeat SRS after previously failed SRS for VS is associated with high tumor control rates. Cranial nerve outcomes remain favorable, particularly for facial nerve. The rate of hearing loss appears similar to the one related to first SRS.

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“…SRS was performed using various models of the Leksell Gamma knife R (Model U, B, C, 4C, Perfexion and Icon (Elekta AB)). Dose planning was performed using various versions of the Leksell dose planning software (KULA or Leksell Gammaplan) [6,14]. Radiation was delivered in a single session with typical margin dose of 12-13 Gy delivered to the tumor margin.…”

Section: Radiosurgery Techniquementioning

confidence: 99%

“…Stereotactic radiosurgery (SRS) for VS was rst reported in 1971 by Leksell [5]. SRS using the Leksell Gamm Knife (GK) (AB Elekta) for small to medium size VSs has a resection free rate of over 95% in 10 years with an associated transient facial neuropathy rate of 1-5% and a serviceable hearing preservation rate of 43-68% at 5 years after SRS [6][7][8][9]. Early SRS after diagnosis improves hearing preservation [10,11].…”

Section: Introductionmentioning

confidence: 99%

Usefull Hearing Preservation Is Improved in Vestibular Schwannoma Patients Who Undergo Stereotactic Radiosurgery Before Further Hearing Deterioration Ensures

Kano

Ogino

Long

et al. 2021

Preprint

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IntroductionThe present study evaluates whether hearing deterioration during observation reduces serviceable hearing preservation rates after stereotactic radiosurgery (SRS) in vestibular schwannoma (VS) patients with useful hearing.MethodsWe retrospectively analyzed 1447 VS patients who underwent SRS between 1992 to 2017. We identified 100 VS patients who had Grade I Gardner- Robertson (GR) hearing at initial diagnosis but were observed without surgery or SRS. We compared hearing after SRS in 67 patients who retained GR Grade I hearing from initial diagnosis to SRS (the hearing maintenance or HM group) to 33 patients whose hearing worsened from GR grade I to grade II (the hearing deterioration or HD group). We also investigated whether a decline in pure tone average (PTA) or speech discrimination score (SDS) before SRS affected hearing preservation after SRS.ResultsThe serviceable hearing (GR I and II) preservation in HM patients was 80%s, 63%, and 51% at 3, 5, and 10 years, respectively. The serviceable hearing preservation in HD patients was 40%, 33%, and 20% at 3, 5, and 10 years, respectively. In multivariate analysis, younger age (<55 years, p=0.012) and HM during observation (p<0.001) improved serviceable hearing preservation rates. Patients whose PTA increased >15 dB (p=0.011) or whose SDS declined >10% (p=0.024) had reduced serviceable hearing preservation rates.ConclusionsHearing deterioration during observation before SRS reduced long term hearing preservation rate in VS patients with GR grade I hearing at initial diagnosis. SRS before hearing deterioration was recommended for hearing preservation.

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Long term results of primary radiosurgery for vestibular schwannomas

Cited by 61 publications

References 28 publications

Vestibular Schwannoma Tumor Size and Growth Rate Predict Response with Gamma Knife Stereotactic Radiosurgery

Vestibular Schwannoma Tumor Size and Growth Rate Predict Response with Gamma Knife Stereotactic Radiosurgery

Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

Usefull Hearing Preservation Is Improved in Vestibular Schwannoma Patients Who Undergo Stereotactic Radiosurgery Before Further Hearing Deterioration Ensures

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