Stereotactic Radiosurgery for Vestibular Schwannomas

German, Michael; Zardouz, Shawn; Sina, Mehdi K.; Ziai, Kasra; Djalilian, Hamid R.

doi:10.1097/mao.0b013e31821e192f

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…16,35-38 Preservation of hearing and minimizing cranial nerve damage have guided therapeutic options, and radiosurgery is being used more frequently by neurotologists in VS treatment. 18 …”

Section: Discussionmentioning

confidence: 99%

“…17 Neurotologists are increasingly using single- or multisession stereotactic radiosurgery to treat VS, with 37% of VS patients seen by neurotologists receiving either Gamma Knife or CyberKnife therapy with a tumor control rate of 74% to 100%. 18-22 To date, investigations on CyberKnife-based treatments for VS are primarily single-institution studies with relatively small sample sizes. No meta-analysis has been performed exclusively examining VS treatment with CyberKnife, although similar studies have been conducted on Gamma Knife radiosurgery.…”

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confidence: 99%

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CyberKnife for Treatment of Vestibular Schwannoma: A Meta‐analysis

Mahboubi

Sahyouni

Moshtaghi

et al. 2017

Otolaryngol.--head neck surg.

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Objectives. (1) Perform a meta-analysis of the available data on the outcomes of CyberKnife radiosurgery for treatment of vestibular schwannomas (VSs) in the published English-language literature and (2) evaluate the collective outcomes of CyberKnife treatment with respect to tumor control and hearing preservation. Data Sources. A thorough literature search of published English-language articles was performed in the PubMed, Ovid, and Cochrane databases. Review Methods. A database search was conducted with the keywords “CyberKnife” and “vestibular schwannoma” or “acoustic neuroma.” A total of 25 papers were found and reviewed. Data were extracted for patient demographics, number of patients with neurofibromatosis type 2, pretreatment hearing status, tumor size, margin dose, and follow-up duration. The primary outcome variables evaluated were tumor control and hearing preservation. Results. After careful review of the published articles, 11 papers reported data on outcomes of CyberKnife treatment for VS and were included in the analysis, comprising 800 patients studied during 1998 to 2012. The reported mean tumor volume ranged from 0.02 to 19.8 cm3, and the follow-up duration ranged from 6 to 120 months. Margin dose varied from 14 to 25 Gy. The collective mean tumor control rate was 96.3% (95% CI: 94.0%-98.5%). The collective hearing preservation rate was 79.1% (95% CI: 71.0%-87.3%) in 427 patients with measurable hearing. Conclusion. Clinical data on outcomes of CyberKnife radiosurgery for treatment of VSs are sparse and primarily limited to single-institution analyses, with considerable variation in tumor volume and follow-up time. This meta-analysis not only provides an in-depth analysis of available data in the literature but also reviews reported outcomes and complications.

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“…16,35-38 Preservation of hearing and minimizing cranial nerve damage have guided therapeutic options, and radiosurgery is being used more frequently by neurotologists in VS treatment. 18 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

CyberKnife for Treatment of Vestibular Schwannoma: A Meta‐analysis

Mahboubi

Sahyouni

Moshtaghi

et al. 2017

Otolaryngol.--head neck surg.

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“…Studies comparing radiotherapy treatments to microsurgery have reported better hearing preservation outcomes of radiosurgery (RS) compared with microsurgery (Pollock et al, 2006) although the debate continues given the heterogeneity of sample and methodology used in the literature. A recent survey of neurotologist reported increase preference of treating these tumors with stereotactic radiotherapy (SRT) over microsurgery (German et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Frameless Fractionated Stereotactic Radiosurgery for Vestibular Schwannomas: A Single-Institution Experience

Karam¹,

Tai²,

Strohl³

et al. 2013

Front. Oncol.

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Objective: To examine tumor control, hearing preservation, and complication rates after frameless fractionated stereotactic radiosurgery (SRS) in patients with vestibular schwannomas (VS).Methods: Thirty-seven patients treated with fractionated SRS from 2002 to 2011 were retrospectively analyzed. Ninety-five percent were treated with 25 Gy in five fractions, targeting a median tumor volume of 1.03 cc (range 0.14–7.60).Results: With a median follow-up of 4.25 years (range, 15 months–9 years), no tumors required an additional treatment resulting in 100% tumor control rate. Radiographic control rate was 91% in 32 patients at a median follow-up of 3 years. Of the 14 patients with serviceable hearing and with audiograms, the hearing preservation rate was 78% at a median follow-up of 18 months. Twenty-six patients with serviceable hearing pretreatment, were evaluated by a phone survey with a hearing preservation rate of 73% at a 5 year median follow-up. There were two cases that developed both new increased trigeminal parasthesias and facial spasms but there were no cases of facial weakness. Patient had 96% of good to excellent satisfaction rate with the treatment at a median follow-up of 5 years.Conclusion: Frameless fractionated SRS treatment of VS results in good rate of tumor control. Hearing preservation rate and rates of cranial nerve toxicity are comparable to what is reported in the literature. Patients choose this modality because of its non-invasive nature and are generally very satisfied with their long term outcome.

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“…In our program, 2.5 cm represents an informal limit for the utilization of Gamma Knife. Such a limit is commonly considered among radiation oncologists and neurotologists performing stereotactic radiosurgery (29). In addition, tumor size at initial presentation positively correlates with the likelihood of subsequent growth when observed (30).…”

Section: Hearing Statusmentioning

confidence: 99%

Impact of Demographics and Clinical Features on Initial Treatment Pathway for Vestibular Schwannoma

et al. 2022

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Objective: To identify demographic and clinical features impacting initial treatment pathway for vestibular schwannoma. Study Design: Retrospective chart review. Setting: Tertiary care academic medical center. Patients: Patients diagnosed with vestibular schwannoma between 2009 and 2019. Interventions: Observation, stereotactic radiosurgery, or microsurgical resection. Main Outcome Measures: χ 2 Test, one-way analysis of variance, and multivariate logistic regression were used to correlate demographic and clinical factors with initial treatment pathway for 197 newly diagnosed vestibular schwannoma patients. Results: Among 197 patients, 93 (47%) were initially treated with observation, 60 (30%) with stereotactic radiation (Gamma Knife) and 44 (22%) with surgical resection. Age univariately had no statistically significant impact on initial pathway, but those undergoing surgery trended toward a younger demographic (49.1 yr [surgery] versus 57.2 yr [observation] versus 59.0 yr [Gamma Knife]).Men were more likely to be initially observed than women ( p = 0.04). Patients initially observed were more likely to have a lower Koos classification ( p < 0.001) and have better tumor-ear hearing ( p = 0.03). Only 34.4% of patients living outside the local geographic region were initially observed compared with 53.0% living locally ( p = 0.055). Surgeon correlated with initial treatment ( p = 0.04) but did not maintain significance when adjusting for hearing level or tumor size. A multiple linear regression model found age, maximum tumor diameter, and Koos class to correlate with initial treatment pathway ( p < 0.0001, r 2 = 0.42). Conclusion: Initial treatment pathway for newly diagnosed vestibular schwannoma is impacted by demographic factors such as age, sex, and geographic proximity to the medical center. Clinical features including hearing level and tumor size also correlated with initial treatment modality.

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Stereotactic Radiosurgery for Vestibular Schwannomas

Cited by 15 publications

References 10 publications

CyberKnife for Treatment of Vestibular Schwannoma: A Meta‐analysis

CyberKnife for Treatment of Vestibular Schwannoma: A Meta‐analysis

Frameless Fractionated Stereotactic Radiosurgery for Vestibular Schwannomas: A Single-Institution Experience

Impact of Demographics and Clinical Features on Initial Treatment Pathway for Vestibular Schwannoma

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