Stereotactic Radiosurgery as the Primary Management for Patients with Koos Grade IV Vestibular Schwannomas

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

doi:10.1093/neuros/nyaa447_620

Cited by 4 publications

(9 citation statements)

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“…We also observed that age and sex distribution of the ITH cohort were consistent with the existing literature on VS, indicating no apparent association between age or sex and ITH risk. 13,21,22 In our study, ITH development showed an indolent course and slow clinical manifestation, with a median of 10 months (IQR, 5-66) after SRS. As a result, 23 patients were initially observed, and only 2 of them required delayed resection because of late ITH expansion.…”

Section: Ith Characteristics and Risk Factorsmentioning

confidence: 51%

Intratumoral Hemorrhage in Vestibular Schwannomas After Stereotactic Radiosurgery: Multi-Institutional Study

Bin-Alamer,

Abou-Al-Shaar,

Mallela

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) after stereotactic radiosurgery (SRS) is exceedingly rare. The aim of this study was to define its incidence and describe its management and outcomes in this subset of patients. METHODS: A retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation. RESULTS: A total of 25 patients developed ITH (cumulative incidence of 0.26%) after SRS management, with a median ITH size of 1.2 cm3. Most of the patients had Koos grade II-IV VS, and the median age was 62 years. After ITH development, 21 patients were observed, 2 had urgent surgical intervention, and 2 were initially observed and had late resection because of delayed hemorrhagic expansion and/or clinical deterioration. The histopathology of the resected tumors showed typical, benign VS histology without sclerosis, along with chronic inflammatory cells and multiple fragments of hemorrhage. At the last follow-up, 17 patients improved and 8 remained clinically stable. CONCLUSION: ITH after SRS for VS is extremely rare but has various clinical manifestations and severity. The management paradigm should be individualized based on patient-specific factors, rapidity of clinical and/or radiographic progression, ITH expansion, and overall patient condition.

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Section: Ith Characteristics and Risk Factorsmentioning

confidence: 51%

Intratumoral Hemorrhage in Vestibular Schwannomas After Stereotactic Radiosurgery: Multi-Institutional Study

Bin-Alamer,

Abou-Al-Shaar,

Mallela

et al. 2023

Neurosurgery

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“…These high symptom control rates were achieved despite patient vulnerability to symptom deterioration pertaining to the age factor. In our previous study of Koos grade IV VS treated with SRS, Ogino et al 13 found worse facial nerve outcomes correlated with increased tumor size and margin dose. Ermis et al 22 assessed the effects of SRS doses and various patient and disease factors on vestibular function in patients with VS. Their findings indicated that minimum vestibular doses of 5 Gy or higher resulted in a significant deterioration of dizziness.…”

Section: Symptom Control and Adverse Radiation Effectsmentioning

confidence: 83%

“…Such outcomes are comparable with other studies in younger patient groups. In a previous study of 170 Koos IV patients with VS (median age: 61 years) at our center, Ogino et al 13 reported a 93.7% tumor control rate at the 5-year follow-up and found a higher tumor control rate with >12 Gy margin dose. A recent multi-institutional retrospective study investigated SRS for Koos grade IV VS in patients ≥ 65 years of age.…”

Section: Tumor Controlmentioning

confidence: 86%

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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“…Our outcomes are similar to those reported in the surgical series of NF2-associated VSs but contrast with published data on sporadic VSs, where tumor control rates at 10 years vary between 90% and 98%. 4-6,19-21 By contrast, in a systematic review of NF2-associated VSs, surgical resection alone resulted in a 45.4% recurrence rate during an average follow-up time of 4.15 years. 22 Comparatively, of tumors that had prior surgery (N = 96) in this study, the type of SRS (adjuvant or salvage after recurrence) was specified in 72 tumors.…”

Section: Discussionmentioning

confidence: 94%

“…3 Despite the increasing use of SRS as a management strategy for NF2-associated VSs, concerns persist related to late treatment failure and radiation-related new tumor development or malignant transformation. [4][5][6][7] The literature presents only a handful of NF2-associated VS malignant transformation case reports with most of the NF2 case series often having short to intermediate follow-up intervals. [8][9][10][11][12] This study relied on multicenter retrospective data from centers who participate in the International Radiosurgery Research Foundation (IRRF).…”

mentioning

confidence: 99%

Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

et al. 2023

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BACKGROUND:Vestibular schwannomas (VSs) related to neurofibromatosis type 2 (NF2) are challenging tumors. The increasing use of stereotactic radiosurgery (SRS) necessitates further investigations of its role and safety.OBJECTIVE:To evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiation-related risks of patients with NF2 after SRS for VS.METHODS:We performed a retrospective study of 267 patients with NF2 (328 VSs) who underwent single-session SRS at 12 centers participating in the International Radiosurgery Research Foundation. The median patient age was 31 years (IQR, 21-45 years), and 52% were male.RESULTS:A total of 328 tumors underwent SRS during a median follow-up time of 59 months (IQR, 23-112 months). At 10 and 15 years, the tumor control rates were 77% (95% CI: 69%-84%) and 52% (95% CI: 40%-64%), respectively, and the FFAT rate were 85% (95% CI: 79%-90%) and 75% (95% CI: 65%-86%), respectively. At 5 and 10 years, the serviceable hearing preservation rates were 64% (95% CI: 55%-75%) and 35% (95% CI: 25%-54%), respectively. In the multivariate analysis, age (hazards ratio: 1.03 [95% CI: 1.01-1.05]; P = .02) and bilateral VSs (hazards ratio: 4.56 [95% CI: 1.05-19.78]; P = .04) were predictors for serviceable hearing loss. Neither radiation-induced tumors nor malignant transformation were encountered in this cohort.CONCLUSION:Although the absolute volumetric tumor progression rate was 48% at 15 years, the rate of FFAT related to VS was 75% at 15 years after SRS. None of the patients with NF2-related VS developed a new radiation-related neoplasm or malignant transformation after SRS.

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Stereotactic Radiosurgery as the Primary Management for Patients with Koos Grade IV Vestibular Schwannomas

Cited by 4 publications

References 0 publications

Intratumoral Hemorrhage in Vestibular Schwannomas After Stereotactic Radiosurgery: Multi-Institutional Study

Intratumoral Hemorrhage in Vestibular Schwannomas After Stereotactic Radiosurgery: Multi-Institutional Study

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

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