Population-Based Study of Stereotactic Radiosurgery or Fractionated Stereotactic Radiation Therapy for Vestibular Schwannoma: Long-Term Outcomes and Toxicities

Lo, Andrea; Ayre, G.; Ma, Roy; Hsu, Fred; Akagami, Ryojo; McKenzie, Michael; Valev, Boris; Gete, E.; Vallières, Isabelle; Nichol, Alan

doi:10.1016/j.ijrobp.2017.09.024

Cited by 18 publications

(15 citation statements)

References 37 publications

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“…Neither pretreatment GR class nor mean dose delivered to the cochlea predicted hearing deterioration on multivariable analysis, although pretreatment PTA did predict hearing preservation on multivariable analysis. 47 These findings are similar to previously discussed SRS outcomes, with long-term follow-up revealing hearing preservation rates under 30%. With respect to hypofractionated protocols consisting of 3 to 5 fractions, there is substantially less data.…”

Section: Fractionationsupporting

confidence: 90%

“…46 In a long-term follow-up study, Lo and colleagues evaluated 49 VS patients with serviceable hearing treated with SRT (50 Gy delivered over 25 fractions) and found hearing preservation rates of 55% at 3 years, 37% at 5 years, and 29% at 7 years. 47 With a median follow-up of 6 years, ipsilateral PTAs worsened from 27 to 53 dB and word recognition scores decreased from 90 to 68%, posttreatment. Neither pretreatment GR class nor mean dose delivered to the cochlea predicted hearing deterioration on multivariable analysis, although pretreatment PTA did predict hearing preservation on multivariable analysis.…”

Section: Fractionationmentioning

confidence: 91%

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Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Tolisano

Hunter

2019

J Neurol Surg B

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Despite no universally accepted definition of hearing preservation following vestibular schwannoma (VS) treatment, numerous variables have been identified as possible factors that may affect hearing outcomes following radiotherapy. Age, pretreatment hearing, radiation dose, tumor location and size, length of follow-up, fractionation, and timing of radiation have all been explored, among other variables, as factors related to hearing outcomes following radiation. These variables and associated hearing outcomes will be explored in detail, summarizing the literature to date to improve patient counseling for those patients who present with serviceable hearing and are considering their VS management options.

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Section: Fractionationsupporting

confidence: 90%

Section: Fractionationmentioning

confidence: 91%

Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Tolisano

Hunter

2019

J Neurol Surg B

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“…Comparisons of GKR treatment outcomes according to initial tumor size indicated a positive correlation between tumor volume control and smaller initial tumor volume (Table 3). There was no significant difference in the changes in neurological symptoms according to initial tumor volume and patient age ( Table 5, 6).…”

Section: Resultsmentioning

confidence: 91%

“…Accurate GKR software programs to plan treatment margins, dose, and fractions based on the radiological workup of patients have been developed. Moreover, MR resolution is in a range that is specific and suitable for GKR 1,6,8,15) . In our study, increased tumor size and deterioration of neurologic symptoms was generally associated with initial tumor size.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiologic Results from the Long-Term Follow-Up of More than 10 Years in Patients Undergoing Gamma Knife Radiosurgery for Vestibular Schwannoma

Kim

Lee

Kwon

et al. 2019

Nerve

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Vestibular schwannoma (VS) is a benign, slow-growing tumor originating from Schwann cells of the cranial nerve. Many studies have reported short-term follow-ups of patients with VS undergoing gamma knife radiosurgery (GKR). This study analyzed factors affecting the treatment and prognosis of patients over a 10-year period who underwent GKR at a single center by 1 surgeon. Methods: Between 1990 and 2003, we used GKR as a primary treatment or after prior surgical tumor removal for patients with VS. During this period, a single surgeon in 1 center treated more than 700 patients. Of these, 182 patients available for long-term follow-up via the outpatient department were included in the study. Among them, 156 patients were available for radiological imaging follow-up; patients who were not available for radiological follow-up were excluded. Initial tumor volume, initial prescription dose, prior surgery, neurological symptom improvement, and tumor control by individual status were assessed to analyze the factors associated with treatment outcomes. Results: Analysis revealed that a smaller initial volume led to better outcomes of tumor control. Conclusion: At more than 10years' follow-up, GKR for VS was effective for tumor control in 91.0% of cases and there were few complications associated with GKR. With improvements in the technology and precision of gamma knife systems, planning programs, and other treatment protocols such as fraction and low marginal dose, we should continuously study following results. Our study results suggest the need for more effective methods for tumor control and fewer neurological and GKR-associated complications.

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“…Conventional fractionated regimens using 45-54 in 1.8-2.0 Gy per fraction to PTV margin are recommended (46)(47)(48). The 5-year TCR and 5-year hearing function preservation rate were 87-98.5% and 54-94%, respectively (49)(50)(51)(52)(53)(54)(55)(56)(57)(58). The introduction of CyberKnife in early 2000 provides another option to treat VS with hypofractionated SRS, using 18 Gy in 3 fractions or 20-25 Gy in 5 fractions.…”

Section: Discussionmentioning

confidence: 99%

Outcome of reduced-dose stereotactic radiosurgery for patients with vestibular schwannoma

Chew¹,

Lee²,

Chen³

et al. 2022

Ther Radiol Oncol

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Background: Stereotactic radiosurgery (SRS) is a minimally invasive intervention for vestibular schwannoma (VS) patients. Post-SRS neurological complications are found to be highly correlated with radiation dose. Herein, we presented the outcome of VS patients treated with SRS with a reduced marginal dose. Methods:We included VS patients treated with Linear Accelerator (LINAC)-based single-fraction SRS from June 2002 to June 2020. A neurosurgeon and two radiation oncologists retrospectively reviewed all data. Patients were divided into two groups according to the prescribed marginal dose: the standard-dose group (≥12 Gy) and the low-dose group (<12 Gy). The prescribed irradiation dose covered at least 95% of the planning target volume (PTV). Outcome evaluations included tumor control rate (TCR) which was defined as the absence of symptoms and evidence of tumor growth requiring salvage treatment, radiological response, and treatment-related toxicity.Results: Fifty patients were included for the analysis, including 26 females and 24 males. The median age was 58 years (20-82 years). The median maximal tumor diameter and volume were 18.30 mm (5.0-34.0 mm) and 0.9 cm 3 (0.1-15.1 cm 3 ). Median marginal doses in the standard-and low-dose groups were 12 Gy (12-15 Gy; n=22) and 9 Gy (8-11 Gy; n=28). The median duration of follow-up was 62 months (3-170 months).TCR for the overall, standard-dose, and low-dose groups were 98%, 100%, and 96.4%, respectively (P=0.389). The rates of radiological tumor shrinkage, stability, and growth were 63.7%, 36.3%, and 0% in the standard-dose group; and, 46.4%, 50.0%, and 3.6% in the low-dose group (P=0.465). The rates of clinical improvement, stability, and deterioration were 48% (n=24), 40% (n=20), and 2% (n=1), respectively.Five patients (10%) developed post-SRS grade 1-2 toxicity. Of these, two patients (one standard-and one low-dose) required ventriculoperitoneal (VP) shunting for hydrocephalus. There was no trigeminal and facial neuropathy.Conclusions: LINAC-based SRS with a marginal dose of 9 Gy demonstrated similar tumor control and treatment-related toxicities compared with a standard dose. Further prospective trials with a large population are warranted to verify our results.

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Population-Based Study of Stereotactic Radiosurgery or Fractionated Stereotactic Radiation Therapy for Vestibular Schwannoma: Long-Term Outcomes and Toxicities

Cited by 18 publications

References 37 publications

Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Hearing Preservation in Stereotactic Radiosurgery for Vestibular Schwannoma

Clinical and Radiologic Results from the Long-Term Follow-Up of More than 10 Years in Patients Undergoing Gamma Knife Radiosurgery for Vestibular Schwannoma

Outcome of reduced-dose stereotactic radiosurgery for patients with vestibular schwannoma

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