Long-term volumetric analysis of vestibular schwannomas following stereotactic radiotherapy: Practical implications for follow-up

Fouard, O.; Daisne, Jean-François; Wanet, Marie; Régnier, Marion; Gustin, Thierry

doi:10.1016/j.ctro.2021.12.003

Cited by 10 publications

(12 citation statements)

References 36 publications

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“…The tumor volume can thus decrease significantly initially after treatment in patients with failed medium-to long-term tumor control. Other authors have reported similar observations [12,17,22].…”

Section: Tumor Volume Changes In Patients With Failed Radiosurgery Fo...supporting

confidence: 75%

“…Modifications of MR imaging after radiosurgery for VS have been studied in some series [17][18][19][20]. Transient tumor volume increase and loss of contrast enhancement are well-known phenomena [18,19,[21][22][23][24][25]. However, the presence of these changes in follow-up MRI of patients with failed therapy has not been well analyzed.…”

Section: Imaging After Radiosurgery For Vsmentioning

confidence: 99%

Section: Tumor Volume Changes In Patients With Failed Radiosurgery Fo...mentioning

confidence: 99%

“…In the literature, a transient increase of tumor volume following radiosurgery, also called sometimes "pseudo-progression," has been extensively reported [20,22,28]. This occurred mainly in the first year after irradiation, but sometimes it can occur for up to 3-5 years after the treatment [22,28]. The rate of transient tumor swelling is highly variable in the series reported, often because of different methods used for measurement of the tumor volume [18,22].…”

Section: Tumor Volume Changes In Patients With Failed Radiosurgery Fo...mentioning

confidence: 99%

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MRI Changes in Failed Radiosurgery for Vestibular Schwannomas

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Renier²

2022

Stereotact Funct Neurosurg

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Introduction: Radiosurgery is now a recognized treatment of vestibular schwannoma (VS); however, radiosurgical irradiation sometimes fails to stop tumor growth in the long term. Some changes in MR imaging after radiosurgery that are supposed to be related to permanent tumor control may be observed in patients with failed treatment. The objective of the present study was to evaluate the MRI changes observed early after radiosurgery in a cohort of patients with failed radiosurgery for VS. Methods: From a large series of VS treated radiosurgically for 15 years, we reviewed the follow-up MRI data in a subgroup of VS that presented obvious treatment failure. T1-weighted MR imaging with standard timing of gadolinium injection was applied for image acquisition during the radiosurgical procedure and all follow-up MR imaging. Evolution of tumor volume and contrast enhancement were assessed on 3D-co-registered MRI. Results: Twenty-nine of 728 patients (4%) were retreated for the same VS after >2 years (median 3.14 years, range 2.04–9.47) following initial radiosurgical treatment. The median tumor volume was 0.94 cc at first radiosurgical treatment and 2.19 cc at retreatment. Fourteen patients (48.3%) had continuous increase in tumor volume. For 10 patients (34.5%), the tumor volume reduced significantly after irradiation before it increased again. Four patients (13.8%) showed a transient increase in tumor volume after irradiation, followed by significant volume reduction, then a very significant tumor regrowth. A significant loss of contrast enhancement at the center of the tumor was observed for 25 patients (86.2%); full recovery of contrast enhancement of the tumor was observed for 23 patients. Discussion/Conclusion: Tumor volume reduction and central loss of contrast enhancement of the tumor are MRI changes frequently observed during follow-up of VS treated radiosurgically even in patients with failed long-term tumor control and may therefore not be considered as signs of successful response of the tumor to the radiosurgical treatment.

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Section: Tumor Volume Changes In Patients With Failed Radiosurgery Fo...supporting

confidence: 75%

Section: Imaging After Radiosurgery For Vsmentioning

confidence: 99%

Section: Tumor Volume Changes In Patients With Failed Radiosurgery Fo...mentioning

confidence: 99%

Section: Tumor Volume Changes In Patients With Failed Radiosurgery Fo...mentioning

confidence: 99%

See 2 more Smart Citations

MRI Changes in Failed Radiosurgery for Vestibular Schwannomas

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Renier²

2022

Stereotact Funct Neurosurg

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“…Tumor progression or recurrence was defined as a more than 10% increase in the tumor volume compared with pretreatment volume. Tumor pseudoprogression, or an early transient increase in the tumor volume after SRS, was not separately evaluated since it cannot be differentiated from true tumor progression in the first five years of follow-up (9,10). Tumor control was defined as the arrest of tumor growth without progression or a decrease in the tumor volume.…”

Section: Treatment Modality and Outcome Assessmentmentioning

confidence: 99%

Vestibular schwannoma associated with neurofibromatosis type 2: Clinical course following stereotactic radiosurgery

et al. 2022

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Objective: A lack of understanding of the clinical course of neurofibromatosis type 2 (NF2)-associated vestibular schwannoma (VS) often complicates the decision-making in terms of optimal timing and mode of treatment. We investigated the outcomes of stereotactic radiosurgery (SRS) in this population.Methods: We retrospectively analyzed NF2 patients treated with Gamma-Knife SRS for VS in our tertiary referral center. A total of 41 treated lesions from 33 patients were collected with a follow-up period of 69.1 (45.0-104.8) months. We reviewed the treatment history, hearing function, and other treatmentrelated morbidities in individual cases. We also analyzed pre-and posttreatment tumor volumes via imaging studies. Longitudinal volumetric analyses were conducted for the tumor volume response of the 41 treated lesions following SRS. The growth pattern of 22 unirradiated lesions during an observation period of 83.4 (61.1-120.4) months was separately evaluated.Results: Most treated lesions showed effective tumor control up to 85% at 60 months after SRS, whereas unirradiated lesions progressed with a relative volume increase of 14.0% (7.8-27.0) per year during the observation period. Twelve (29%) cases showed pseudoprogression with significant volume expansion in the early follow-up period, which practically reduced the rate of tumor control to 57% at 24 months. Among the patients with serviceable hearing, two (20%) cases lost the hearing function on the treated side during the early follow-up period within 24 months.

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Stereotactic Radiosurgery and Radiotherapy for Vestibular Schwannoma in NF2‐Related Schwannomatosis

Shrivastava,

Emmanouil,

Mathew

et al. 2023

The Laryngoscope

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ObjectivesTo determine the long‐term control rates and hearing outcomes for growing vestibular schwannoma in NF2‐related schwannomatosis (NF2) treated with stereotactic radiosurgery (SRS) and fractionated radiotherapy (FRT).MethodsRetrospective review of all patients treated with SRS/FRT between 1986 and2021 from a tertiary NF2 unit. Overall tumor control was defined as: (1) growth control (growth failure was defined as growth in any dimension of 3 millimetres or more from baseline post‐SRS/FRT), and (2) treatment control (no need for further intervention). Loss of serviceable hearing was defined as a drop in speech discrimination score below 50% after SRS/FRT.ResultsThere were 81 cases, with a mean duration of follow‐up of 125 months. Overall control rate was 72% (58/81), with 80% (65/81) growth control and 74% (60/81) treatment control. There was a 5‐year actuarial survival of 77% and 10‐year survival of 71%. Forty‐three percent (30/69) of cases did not have serviceable hearing at baseline. Of those remaining, 49% (19/39) preserved serviceable hearing during follow‐up at a mean of 106 months. Actuarial survival for preservation of serviceable hearing at 5 and 10 years was 69% and 53%. There were poorer outcomes with increasing genetic severity, and with baseline tumor size >3 cm. No cases of SRS/FRT‐related malignancy were identified at a mean follow‐up of 10 years.ConclusionStereotactic radiosurgery/fractionated radiotherapy are an effective option to treat growing vestibular schwannoma in patients with NF2 with the potential for hearing preservation in a proportion of patients.Level of EvidenceLevel 4—Case Series Laryngoscope, 2023

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Long-term volumetric analysis of vestibular schwannomas following stereotactic radiotherapy: Practical implications for follow-up

Abstract: Highlights Pseudoprogression may be a late phenomenon after radiosurgery. Loss of central contrast enhancement is not predictive of tumor control. No decision of salvage therapy should be made until the 6th year post-treatment.

Cited by 10 publications

References 36 publications

MRI Changes in Failed Radiosurgery for Vestibular Schwannomas

MRI Changes in Failed Radiosurgery for Vestibular Schwannomas

Vestibular schwannoma associated with neurofibromatosis type 2: Clinical course following stereotactic radiosurgery

Stereotactic Radiosurgery and Radiotherapy for Vestibular Schwannoma in NF2‐Related Schwannomatosis

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