Multisession Stereotactic Radiosurgery for Vestibular Schwannomas

Hansasuta, Ake; Choi, Chang-Hoon; Gibbs, Iris C.; Soltys, Scott G.; Tse, Victor; Lieberson, Robert E.; Hayden, Melanie; Sakamoto, Gordon T.; Harsh, Griffith R.; Adler, John R.; Chang, Steven D.

doi:10.1227/neu.0b013e318222e451

Cited by 77 publications

(75 citation statements)

References 82 publications

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“…13 We wish to emphasize the following points: 1) multisession SRS should not necessarily be limited to elderly patients harboring large VSs or patients affected by comorbidities. Further experiences with larger numbers of young patients and longer follow-up controls are needed to recommend multisession SRS for young people af- fected by large VSs; long-term tumor control and malignant transformation are matters of concern.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the current standard therapeutic dose (12-13 Gy) may be too high and not well tolerated by healthy surrounding nervous structures, with potential adverse radiation effects, without effecting rapid volume reduction. 3,42 Multisession stereotactic radiosurgery (SRS) 1,5,6,13,17 performed using the CyberKnife (Accuray Inc.) in 2-5 fractions has been the main therapeutic choice at our institution since January 2003 for patients harboring VSs. The present study will contribute to the debate on the therapeutic strategies for VSs, by showing disease outcomes following multisession SRS in a series of patients with lesions larger than 8 cm ).…”

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confidence: 99%

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Multisession stereotactic radiosurgery for large vestibular schwannomas

Casentini

Fornezza

Perini

et al. 2015

JNS

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OBJECT Microsurgery is not the only option for larger vestibular schwannomas (VSs); recent reviews have confirmed the feasibility and efficacy of radiosurgery for larger VSs. This study illustrates the outcomes of a series of large VSs after multisession stereotactic radiosurgery (SRS). METHODS A series of 33 VSs larger than 8 cm3 (range 8–24 cm3, mean 11 cm3, median 9.4 cm3) were treated using the CyberKnife from 2003 to 2011 with the multisession SRS technique in 2–5 fractions (14–19.5 Gy). Five patients had undergone surgical removal and 5 had ventriculoperitoneal shunts. Nine patients were eligible for but refused surgery. Twelve patients were older than 70 years and 5 were younger than 40 years. Two female patients had neurofibromatosis. RESULTS The follow-up period ranged from 12 to 111 months (median 48 months); radiological growth control was achieved in 94% of cases: 19 tumors (58%) displayed no size variation or reduction in tumor diameter; 12 (36%), after a transient enlargement, presented with arrested growth or shrinkage. Seven patients had a volume reduction of more than 50%. Two patients (6%) needed debulking and 2 were treated with ventriculoperitoneal shunts. Actuarial progressionfree survival rates at 1 year and 5 years were 97% and 83%, respectively. Hearing was retained in 7 of the 8 patients with serviceable baseline hearing. Adverse events were limited to 1 case each of vertigo, tongue paresthesia, and trigeminal neuralgia. CONCLUSIONS The good control rate obtained with multisession SRS deepens the controversy of the radiobiology of VSs and may extend the indication of radiation therapy (fractionated or SRS) for large VSs to include patients without symptoms of mass effect. The limited number of cases and short follow-up period do not provide sufficient support for widespread application of multisession SRS in young patients. Further studies with multisession SRS are warranted.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Multisession stereotactic radiosurgery for large vestibular schwannomas

Casentini

Fornezza

Perini

et al. 2015

JNS

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“…Trigeminal dysfunction arose in 8 patients (2%), half of which was transient. 20 In a retrospective series of 117 VS patients treated with 18 Gy over 3 fraction of Cyberknife, 99.1% had excellent tumour control rates, with a mean imaging follow-up of 61.1 months. Eighty percent of them maintained hearing after radiotherapy, with a mean audiometric follow-up of 64.5 months.…”

Section: Fractionated Stereotactic Radiotherapy (Fsrt)mentioning

confidence: 99%

“…Local control with this approach was high (90-100%) but a significant number of adverse effects were observed, first of all hearing loss. 7-10 Foote et al treated 36 patients with acoustic neuromas with SRS using a gamma knife at a dose of [16][17][18][19][20] Gy to the tumour margin. No tumour progression was observed, but the 2-year actuarial rate of preservation of useful hearing was only 41.7%, and the 2-year actuarial incidence of facial or trigeminal neuropathy was 81.7%.…”

Section: Stereotactic Radio-surgery (Srs)mentioning

confidence: 99%

Radiotherapy for vestibular schwannoma: Review of recent literature results

Apicella

Paolini

Deantonio

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…SRS was delivered in three equal fractions over the course of 3 days, to a median marginal dose of 18 Gy prescribed to the 75% to 85% isodose line (radiobiologically equivalent to a 11.3-Gy single dose, using the linear-quadratic model (7) and ␣/␤ ratio of 3 as previously reported (8). The mean conformity index score was 1.23 Ϯ 0.24.…”

Section: Radiosurgery Techniquementioning

confidence: 99%