Editorial: Vestibular schwannoma radiosurgery: progression or pseudoprogression?

Régis, Jean; Delsanti, Christine; Roche, Pièrre-Hugues

doi:10.3171/2016.7.jns161236

Cited by 32 publications

(25 citation statements)

References 33 publications

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“…Patients with <20% increase in tumor volume relative to the BTV at each time interval were considered radiologic responders, those with a ≥20% increase relative to their BTV were radiologic non-responders, and those who required salvage microsurgery were treatment failures. Given the paucity of evidence regarding measures of volumetric response, we reviewed the literature, and on the basis of our clinical judgment, we decided upon a volumetric threshold of 20% above BTVs, which we felt was a conservative estimate to distinguish between progression, the error inherent in estimating volumetric changes using simple tri-dimensional measurements, and pseudoprogression ( 24 , 25 ). If a patient did not have imaging within a particular time interval, they were excluded from the analysis within that time interval.…”

Section: Methodsmentioning

confidence: 99%

Long-term Treatment Response and Patient Outcomes for Vestibular Schwannoma Patients Treated with Hypofractionated Stereotactic Radiotherapy

Patel

Marciscano

et al. 2017

Front. Oncol.

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PurposeThe aim of this study is to evaluate long-term treatment outcome and toxicities among vestibular schwannoma (VS) patients treated with hypofractionated stereotactic radiotherapy (HSRT).Methods383 patients with unilateral VS treated with HSRT (25 Gy, five fractions) between 1995 and 2007 were retrospectively reviewed. Treatment failure was defined as requiring salvage microsurgery. Posttreatment new/progressive clinical symptoms or increases in baseline tumor volume (BTV) due to treatment effect or progression were noted. Symptom outcomes were reported as baseline and posttreatment ± improvement, respectively. Symptoms were grouped by cranial nerve (CN) VII or CNVIII. Audiometry was assessed baseline and posttreatment hearing. Patients were grouped as having greater than serviceable hearing [Gardner Robertson (GR) score 1–2] or less than non-serviceable hearing (GR score 3–5) by audiometry.ResultsMedian follow-up was 72.0 months. Nine (2.3%) experienced treatment failure. At last follow-up, 74 (19.3%) had new/progressive symptoms and were categorized as radiologic non-responders, whereas 300 (78.3%) had no tumor progression and were grouped as radiologic responders. Average pretreatment BTV for treatment failures, radiologic non-responders, and radiologic responders was 2.11, 0.44, and 1.87 cm3, respectively. Pretreatment CNVII and CNVIII symptoms were present in 9.4 and 93.4% of patients, respectively. Eight (24%) with pre-HSRT CNVII and 37 (10%) with pre-HSRT CNVIII symptoms recovered CN function post-HSRT. Thirty-five (9%) and 36 (9.4%) experienced new CNVII and CNVIII deficit, respectively, after HSRT. Of these, 20 (57%) and 18 (50%) recovered CNVII and CNVIII function, respectively, after HSRT. Evaluable audiograms were available in 199 patients. At baseline and at last follow-up, 65.8 and 36.2% had serviceable hearing, respectively. Fifty-one percent had preservation of serviceable hearing at last follow-up.ConclusionTreatment of VS with HSRT is effective with treatment success in 97.7% and an acceptable toxicity profile. Less than one-third of patients experience any new CNVII or CNVIII deficit posttreatment. Greater than 50% of patients with serviceable hearing at baseline maintained hearing function. Improved methods to differentiate treatment effect and tumor progression are needed.

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Section: Methodsmentioning

confidence: 99%

Long-term Treatment Response and Patient Outcomes for Vestibular Schwannoma Patients Treated with Hypofractionated Stereotactic Radiotherapy

Patel

Marciscano

et al. 2017

Front. Oncol.

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“…The reported outcome of large series of centers of high experience and expertise for SRS, facial nerve functional degradation after GKRS, has become anecdotal due to the introduction of robotization. 8,40 Notably, a progressive rate of facial nerve recovery at long-term follow-up following SRS has been shown, compared with the postoperative period, 20,34,50 emphasizing the importance of a long-term evaluation to assess the outcome after adequate tumor shrinkage following SRS. 4…”

Section: Facial Nerve Outcomementioning

confidence: 99%

“…48 The recurrence rate of large VSs after total microsurgical removal is reported to be between 4% and 27% 1,21,25,27,45 and is up to 53% after an STR. 13,22,23,39 The post-GKRS tumor growth control rate has been reported to be as high as 98% 40 in the literature, and a pooled overall tumor control rate of 92.7% was reported in a recent meta-analysis that included more than 3233 patients and a mean follow-up period of 51.24 months. 42 In our analysis, 18 patients (7.3%) had tumor progression, 5 of whom were observed and remained stable over time without any further treatment.…”

Section: Tumor Controlmentioning

confidence: 99%

Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach

Starnoni

Daniel

Tuleasca

et al. 2018

Neurosurgical Focus

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OBJECTIVEDuring the last decade, the primary objective for large vestibular schwannoma (VS) management has progressively shifted, from tumor excision to nerve preservation by using a combined microsurgical and radiosurgical approach. The aim of this study was to provide a systematic review and meta-analysis of the available literature regarding the combined strategy of subtotal resection (STR) followed by stereotactic radiosurgery (SRS) for large VSs.METHODSThe authors performed a systematic review and meta-analysis in compliance with the PRISMA guidelines for article identification and inclusion using the PubMed, Embase, and Cochrane databases. Established inclusion criteria were used to screen all identified relevant articles published before September 2017 without backward date limit.RESULTSThe authors included 9 studies (248 patients). With a weighted mean follow-up of 46 months (range 28–68.8 months), the pooled rate of overall tumor control was 93.9% (95% CI 91.0%–96.8%). Salvage treatment (second STR and/or SRS) was necessary in only 13 (5.24%) of 18 patients who experienced initial treatment failure. According to the House-Brackmann (HB) grading scale, functional facial nerve preservation (HB grade I–II) was achieved in 96.1% of patients (95% CI 93.7%–98.5%). Serviceable hearing after the combined approach was preserved in 59.9% (95% CI 36.5%–83.2%).CONCLUSIONSA combined approach of STR followed by SRS was shown to have excellent clinical and functional outcomes while still achieving a tumor control rate comparable to that obtained with a total resection. Longer-term follow-up and larger patient cohorts are necessary to fully evaluate the rate of tumor control achieved with this approach.

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“…As illustrated in the literature, the decision whether to continue to wait-and-scan or to act by a new therapeutic mean is always a clinical decision and "never just a matter of volume measurements." [8][9][10] Four patients in this series needed a ventriculoperitoneal shunt for persistent hydrocephalus.…”

Section: Tumor Control After Combined Approachmentioning

confidence: 91%

The Changing Paradigm for the Surgical Treatment of Large Vestibular Schwannomas

et al. 2018

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Planned subtotal resection followed by Gamma Knife surgery (GKS) in patients with large vestibular schwannoma (VS) has emerged during the past decade, with the aim of a better functional outcome for facial and cochlear function. We prospectively collected patient data, surgical, and dosimetric parameters of a consecutive series of patients treated by this method at Lausanne University Hospital during the past 8 years. A consecutive series of 47 patients were treated between July 2010 and January 2018. The mean follow-up after surgery was 37.5 months (median: 36, range: 0.5-96). Mean presurgical tumor volume was 11.8 mL (1.47-34.9). Postoperative status showed normal facial nerve function (House-Brackmann I) in all patients. In a subgroup of 28 patients, with serviceable hearing before surgery and in which cochlear nerve preservation was attempted at surgery, 26 (92.8%) retained serviceable hearing. Nineteen had good or excellent hearing (Gardner-Robertson class 1) before surgery, and 16 (84.2%) retained it after surgery. Mean duration between surgery and GKS was 6 months (median: 5, range: 3-13.9). Mean residual volume as compared with the preoperative one at GKS was 31%. Mean marginal dose was 12 Gy (11-12). Mean follow-up after GKS was 34.4 months (6-84). Our data show excellent results in large VS management with a combined approach of microsurgical subtotal resection and GKS on the residual tumor, with regard to the functional outcome and tumor control. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control.

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Editorial: Vestibular schwannoma radiosurgery: progression or pseudoprogression?

Abstract: FIG. 1. Chart showing comparative evolution of the average total tumor volume (in mm) in percentage of the volume at the time of radiosurgery.

Cited by 32 publications

References 33 publications

Long-term Treatment Response and Patient Outcomes for Vestibular Schwannoma Patients Treated with Hypofractionated Stereotactic Radiotherapy

Long-term Treatment Response and Patient Outcomes for Vestibular Schwannoma Patients Treated with Hypofractionated Stereotactic Radiotherapy

Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach

The Changing Paradigm for the Surgical Treatment of Large Vestibular Schwannomas

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