Clinical Results After Single-fraction Radiosurgery for 1,002 Vestibular Schwannomas

Abstract

Background Herein, we report clinical results for patients treated with stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) over a period of 10 years. Methods Clinical data and imaging follow-up were stored in a database of 1,378 patients, with 1,384 VS treated consecutively between 2005 and 2018 and analyzed retrospectively. A total of 996 patients with 1,002 tumors with at least one year of follow-up were included for analysis. Results Median follow-up was 3•6 years (1-12•5 years). The three, five, and 10-year Kaplan-Meier estimated local tumor control was 96•6%, 92•3%, and 90•8%, respectively. The median hearing loss of the affected ear as compared to its healthy counterpart was 17 dB at treatment start and increased to 23 and 29 dB at one and five years. Six patients (0•6%) developed symptomatic hydrocephalus and underwent the placement of a ventriculoperitoneal shunt. In 30 patients (3•0%), trigeminal sensory dysfunction developed, five patients (0•5%) had a mild transient weakness, and nine patients (0•9%) had a permanent facial weakness (House-Brackmann Grade > II) after SRS. Conclusion Single fraction SRS proves to be highly effective and shows low treatment-related toxicity for VS. SRS should be considered a primary treatment option for small and middle-sized VS.

Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system

“…Tumor control rates in our series, in those from the literature and in other SRS series with smaller VS 2,5,34-36 , varied between 87-100%. The largest study of Cyberknife ® SRS of VS so far was published by Windisch et al 37 . with> 1000 patients and revealed an overall tumor control rate of 92% after five years.…”

“…Regarding this study it has to be mentioned that tumor control was defined as increased size in two consecutive FU, which differs from other studies mentioned in Table 4. Since Windisch et al 37 did not measure tumor size or volume systematically in FU and Koos grades were not defined their findings remain vague. In our study, successful tumor control after SRS does not depend on tumor volume and/or Koos grade.…”

Longitudinal Changes of Quality of Life and Hearing Following Radiosurgery for Vestibular Schwannoma

“…Stereotactic radiosurgery (SRS) has become a mainstay in the treatment of vestibular schwannomas (VS) due to achieving results comparable to surgical resection for small and middle-sized tumors and potentially lowering patient burden [ 1 , 2 ]. As both methods appear to achieve equally high local control rates, the impact of treatment choice on the patient’s quality of life (QoL) has emerged as another important consideration [ 3 ].…”

“…As many treatment-related toxicities associated with SRS for VS are transient, and pseudoprogression is frequently observed within the first 24 months after treatment, patients may report worsened QoL during early follow-up [ 2 , 10 ].…”

Vestibular Migraine Following Radiosurgery for Vestibular Schwannoma

“…There are three main treatment modalities for VS: microsurgery, stereotactic radiosurgery (SRS), and observation. Notably, SRS has been suggested as a highly effective and safe option for treating small and medium-sized VS [8]. After surgery or SRS, patients can experience acute vestibular symptoms, including vertigo, dizziness, and imbalance, that significantly impact their quality of life [9,10].…”