Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter

Huang, Cheng-Wei; Tu, Hsien-Tang; Chuang, Chun‐Yi; Chang, Cheng-Chen; Chou, Hsi-Hsien; Lee, Ming‐Tsung; Huang, Chin-Shiu

doi:10.3171/2016.12.jns161530

Cited by 59 publications

(63 citation statements)

References 32 publications

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“…The association of reduced local control with increased tumor volumes has been the subject of ongoing discussion [13]. Analyzing local control for tumors smaller and larger than the median volume (0.61 ccm) resulted in local control of 97.4%, 94.4%, and 94.4% at three, five and 10 years for the smaller and 95.7%, 90.3%, and 87.7% for the larger group, which corresponds to a recent study by Ruess et al where, for a group of 335 patients with a median tumor volume of 1.1 ccm, local control was 89% and 87% at five and 10 years, respectively [14].…”

Section: Local Tumor Controlmentioning

confidence: 99%

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

Windisch¹,

Tonn²,

Fürweger³

et al. 2019

Cureus

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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.

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Section: Local Tumor Controlmentioning

confidence: 99%

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

Windisch¹,

Tonn²,

Fürweger³

et al. 2019

Cureus

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“…3,[6][7][8] This is more apparent for larger tumors, where the balance between adequate tumor control and toxicity of native tissue is often easier to attain with multifraction SRS. 3,[9][10][11] Multifraction SRS may be particularly suitable for controlling symptomatic mass effect of large tumors causing brainstem compression. 12 Following radiosurgery, patients are followed with serial imaging to assess for tumor changes and supplement the clinical examination to evaluate the need for salvage therapy.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Radiographic Outcomes of Vestibular Schwannoma in Single and Fractionated Stereotactic Radiosurgery: A Retrospective Cohort Study

Khattab

Newman

Wharton

et al. 2019

J Neurol Surg B Skull Base

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Management of vestibular schwannoma (VS) includes stereotactic radiosurgery (SRS) in single or fractionated treatments. There is a paucity of literature on the three-dimensional (3D) volumetric kinetics and radiological changes following SRS and no consensus on appropriate post-SRS surveillance imaging timeline. This is a retrospective cohort study with institutional review board approval. A total of 55 patients met study criteria. We collected volumetric kinetic data in VS treated with SRS over time using a target volume contouring software. We also tracked radiographic phenomena such as pseudoprogression and necrosis. A secondary objective was to describe our overall treatment success rate and any failures. For all treatments groups, pseudoprogression most typically occurred within 12 months post-SRS, after which tumor volumes on average normalized and then decreased from pretreatment size at the last follow-up. Only two patients required salvage therapy post-SRS and were considered SRS treatment failures. Both patients were in the five-fraction cohort but with a lower biologically equivalent dose. Our study is first to collect 3D volumetric kinetics of VS following single and fractionated SRS in contrast to extrapolations from single and two-dimensional measurements. Our longitudinal data also show initial increases in volume in the first 12 months post-SRS followed by later declines, setting up interesting questions regarding the utility of early posttreatment surveillance imaging in the asymptomatic patient. Finally, we show low rates of treatment failure (3.6%) and show in our cohort that SRS dose de-escalation posed a risk of treatment failure.

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“…These strategies have shown good results for large VSs and obtained acceptable radiationinduced morbidities. [7][8][9][10][11][12][13][14] Nevertheless, radiosurgical treatments of large VSs remain controversial due to the possible transient tumor enlargement (TTE). This radiation-induced swelling of the tumor, also known as pseudoprogression, occurs in a broad range of 11%-74% of all VS patients in the two to three years following treatment and can cause a temporary increase in cranial nerve morbidities.…”

Section: Introductionmentioning

confidence: 99%

Prediction of transient tumor enlargement using MRI tumor texture after radiosurgery on vestibular schwannoma

et al. 2020

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Purpose: Vestibular schwannomas (VSs) are uncommon benign brain tumors, generally treated using Gamma Knife radiosurgery (GKRS). However, due to the possible adverse effect of transient tumor enlargement (TTE), large VS tumors are often surgically removed instead of treated radiosurgically. Since microsurgery is highly invasive and results in a significant increased risk of complications, GKRS is generally preferred. Therefore, prediction of TTE for large VS tumors can improve overall VS treatment and enable physicians to select the most optimal treatment strategy on an individual basis. Currently, there are no clinical factors known to be predictive for TTE. In this research, we aim at predicting TTE following GKRS using texture features extracted from MRI scans. Methods: We analyzed clinical data of patients with VSs treated at our Gamma Knife center. The data was collected prospectively and included patient-and treatment-related characteristics and MRI scans obtained at day of treatment and at follow-up visits, 6, 12, 24 and 36 months after treatment. The correlations of the patient-and treatment-related characteristics to TTE were investigated using statistical tests. From the treatment scans, we extracted the following MRI image features: first-order statistics, Minkowski functionals (MFs), and three-dimensional gray-level co-occurrence matrices (GLCMs). These features were applied in a machine learning environment for classification of TTE, using support vector machines. Results: In a clinical data set, containing 61 patients presenting obvious non-TTE and 38 patients presenting obvious TTE, we determined that patient-and treatment-related characteristics do not show any correlation to TTE. Furthermore, first-order statistical MRI features and MFs did not significantly show prognostic values using support vector machine classification. However, utilizing a set of 4 GLCM features, we achieved a sensitivity of 0.82 and a specificity of 0.69, showing their prognostic value of TTE. Moreover, these results increased for larger tumor volumes obtaining a sensitivity of 0.77 and a specificity of 0.89 for tumors larger than 6 cm 3 . Conclusions: The results found in this research clearly show that MRI tumor texture provides information that can be employed for predicting TTE. This can form a basis for individual VS treatment selection, further improving overall treatment results. Particularly in patients with large VSs, where the phenomenon of TTE is most relevant and our predictive model performs best, these findings can be implemented in a clinical workflow such that for each patient, the most optimal treatment strategy can be determined.

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Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter

Cited by 59 publications

References 32 publications

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

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

Longitudinal Radiographic Outcomes of Vestibular Schwannoma in Single and Fractionated Stereotactic Radiosurgery: A Retrospective Cohort Study

Prediction of transient tumor enlargement using MRI tumor texture after radiosurgery on vestibular schwannoma

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