Stereotactic radiosurgery as the first-line treatment for intracanalicular vestibular schwannomas

Ogino, Akiyoshi; Lunsford, L. Dade; Long, Hao; Johnson, Stephen A.; Niranjan, Ajay; Flíckinger, John C.; Kano, Hideyuki

doi:10.3171/2020.9.jns202818

Cited by 17 publications

(19 citation statements)

References 33 publications

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“…Comparatively, Ogino et al 13 reported a 5-year serviceable hearing preservation rate of 50.3% among Koos grade IV VS and found a higher chance of preserving serviceable hearing among patients with GR grade I at SRS and those who were younger than 60 years. In another study, Ogino et al 11 investigated intracanalicular VS treated with SRS, and found serviceable hearing preservation rates after SRS of 76.6%, 63.5%, and 27.3% at 3, 5, and 10 years, respectively. The authors also reported age (younger than 55 years) as a statistically significant predictor of serviceable hearing preservation ( P = .011).…”

Section: Discussionmentioning

confidence: 99%

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Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

et al. 2023

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BACKGROUND AND OBJECTIVES: The management of octogenarians with vestibular schwannomas (VS) has received little attention. However, with the increase in octogenarian population, more effort is needed to clarify the value of stereotactic radiosurgery (SRS) in this population. The aim of this study was to evaluate the safety and efficacy of SRS in this patient age group. METHODS: A retrospective study of 62 patients aged 80 years or older who underwent single-session SRS for symptomatic VS during a 35-year interval was performed. The median patient age was 82 years, and 61.3% were male. SRS was performed as planned adjuvant management or for delayed progression after prior partial resection in 5 patients. RESULTS: SRS resulted in a 5-year tumor control rate of 95.6% with a 4.8% risk of adverse radiation effects (ARE). Tumor control was unrelated to patient age, tumor volume, Koos grade, sex, SRS margin dose, or prior surgical management. Four patients underwent additional management including 1 patient with symptomatic progression requiring surgical resection, 2 patients with symptomatic hydrocephalus requiring cerebrospinal fluid diversion, and 1 patient whose tumor-related cyst required delayed cyst aspiration. Three patients developed ARE, including 1 patient with permanent facial weakness (House-Brackmann grade II), 1 who developed trigeminal neuropathy, and 1 who had worsening gait disorder. Six patients had serviceable hearing preservation before SRS, and 2 maintained serviceable hearing preservation after 4 years. A total of 44 (71%) patients died at an interval ranging from 6 to 244 months after SRS. CONCLUSION: SRS resulted in tumor and symptom control in most octogenarian patients with VS.

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Section: Discussionmentioning

confidence: 99%

“…The Gamma Knife planning and treatment protocol were reported previously. 10,11 The median time from VS diagnosis to SRS treatment was 23 months (IQR, 1-51) (Table 1). The median tumor volume was 2.8 cc (IQR, 0.9-5.6), and the VS arose from the right vestibulocochlear nerves in 51.6% of patients.…”

Section: Methodsmentioning

confidence: 99%

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

et al. 2023

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“…While chemotherapy has been documented to improve survival in malignant lesions, radiotherapy as a primary or adjuvant modality aims mainly to halt tumor progression. Studies that investigated the efficacy of radiotherapy for meningiomas and schwannomas reported high 10-year PFS rates of up to 90–98% [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. However, since different tumor types respond differently to various modalities, it is essential to tailor a personalized management plan based on the patient tumor pathology and their clinical condition.…”

Section: Discussionmentioning

confidence: 99%

Tumors Involving the Infratemporal Fossa: A Systematic Review of Clinical Characteristics and Treatment Outcomes

Bin-Alamer

Bhenderu²,

Palmisciano³

et al. 2022

Cancers

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Background: Infratemporal fossa (ITF) tumors represent various pathologies and are seldom described in the literature, reflecting their rarity. Here we review the literature on tumors invading ITF and describe patient characteristics, treatment strategies, and clinical outcomes. Methods: Relevant articles were retrieved from PubMed, Scopus, and Cochrane. A systematic review and meta-analysis were conducted on the clinical presentation, treatment protocols, and clinical outcomes. Result: A total of 27 articles containing 106 patients with ITF tumors (median tumor size: 24.3 cm3 [interquartile range, 15.2–42 cm3]) were included (median age: 46 years [interquartile range, 32–55 years]; 59.4% were males]). Of the confirmed tumor pathology data, schwannomas (n = 24; 26.1%) and meningiomas (n = 13; 14.1%) were the most common tumors. Facial hypoesthesia (n = 22; 18.5%), auricular/preauricular pain (n = 20; 16.8%), and headaches (n = 11; 9.2%) were the most common presenting symptoms. Of patients who had surgical resection (n = 97; 95.1%), 70 (73.7%) had transcranial surgery (TCS) and 25 (26.3%) had endoscopic endonasal surgery (EES). Among available details on the extent of resection (n = 84), gross-total resection (GTR) was achieved in 62 (73.8%), and 5 (6.0%) had biopsy only. Thirty-five (33.0%) patients had postoperative complications. Among cases with available data on reconstruction techniques (n = 8), four (50%) had adipofascial antero-lateral thigh flap, three (37.5%) had latissimus dorsi free flap, and one (12.5%) had antero-lateral thigh flap. Fourteen (13.2%) patients had adjuvant chemotherapy, and sixteen (15.1%) had adjuvant radiotherapy. During a median follow-up time of 28 months (IQR, 12.25–45.75 months), 15 (14.2%) patients had recurrences, and 18 (17.0%) patients died. The median overall survival (OS) time was 36 months (95% confidence interval: 29–41 months), and the 5-year progression-free survival (PFS) rate was 61%. Conclusion: Various tumor types with different biological characteristics invade the ITF. The present study describes patient demographics, clinical presentation, management, and outcomes. Depending on the tumor type and patient condition, patient-tailored management is recommended to optimize treatment outcomes.

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“…Several studies mentioned that a small subgroup of patients received marginal doses of 8-11 Gy. However, their outcomes were not analyzed separately (23,28,38,79,80). The median marginal dose of our lowdose group was 9 Gy.…”

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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Stereotactic radiosurgery as the first-line treatment for intracanalicular vestibular schwannomas

Cited by 17 publications

References 33 publications

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

Tumors Involving the Infratemporal Fossa: A Systematic Review of Clinical Characteristics and Treatment Outcomes

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

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