Management of Vestibular Schwannomas with Linear Accelerator-Based Stereotactic Radiosurgery: A Single Center Experience

Abstract

Linear accelerator-based stereotactic radiosurgery offers a safe and effective treatment for patients with vestibular schwannoma by providing high local control rates along with improved quality of life through well-preserved hearing function.

Vestibular Schwannomas: Surgical and Nonsurgical Management

“…Evaluating success after STR is a challenge due to changes in technology, treatment protocols (radiation dose), and the relatively short duration of follow-up reported and variability in how treatment success is defined. Current studies have a mean follow-up of less than 5 years [31,36,[46][47][48][49][50], and long-term outcomes are often based on actuarial estimates of tumor control and hearing preservation rates [41-43, 46, 47]. There is also significant variability in how successful tumor control or hearing preservation is defined.…”

“…There is also significant variability in how successful tumor control or hearing preservation is defined. For example, some studies define successful tumor control as no growth on follow-up imaging [35,47,50,51], while others report a lack of symptomatic growth or progression that required further treatment [31,42,49]. To illustrate, Vivas [31] reported tumor growth rates and percentage of patients that progressed to further intervention.…”

“…Despite limitations, STR is an effective means of tumor control with reported rates at 71-99 % [29,31,33,35,47,[50][51][52][53]. The variability in control rates reflects a lack of unified parameters whereby in general improved tumor control rates are defined as no growth on follow-up imaging [35].…”

“…The incidence of injury has decreased secondary to lower and more accurate radiation dosing. Nonetheless, facial paresis continues to occur (up to 4 %) [29,41,50], is typically temporary and may improve with steroids, yet can be permanent (1.6 %) [33,41] and is more likely when treating larger tumors [43] or with use of higher radiation doses (13 Gy) [52]. Post-radiation dysfunction of the Fig.…”

“…Pseudo-progression or peritumoral edema occurs in up to 30 % of patients following radiation [47,50,54,61,62] and is symptomatic in 21 % [61,63]. The incidence of edema correlates with tumor size, and larger ([3 cm) tumors have a 50 % rate of pseudo-progression [61].…”