Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution

Andrews, David W.; Suarez, Oscar; Goldman, Howard; Downes, M. Beverly; Bednarz, Greg; Corn, Benjamin W.; Werner‐Wasik, Maria; Rosenstock, Jeffrey G.; Curran, Walter J.

doi:10.1016/s0360-3016(01)01559-0

Cited by 308 publications

(150 citation statements)

References 76 publications

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“…First, this finding is not specific to radiosurgery of NF2 patients, because earlier treatment of a smaller vestibular schwannoma, whether it is sporadic or NF2-associated, with any modalities such as radiosurgery, radiotherapy, and microsurgery generally leads to a better hearing outcome. 5,[19][20][21] Second, more data regarding this issue must be collected because the statistical power of the present study was not convincingly high. Last, the apparent benefits of early treatment may reflect a well-known bias, that is, the patients diagnosed and treated earlier only appear to do better, although the long-term outcome is in fact unchanged.…”

Section: Discussionmentioning

confidence: 84%

“…Interestingly, NF2 was significantly associated with adverse outcomes in this study, with an actuarial 5-year hearing preservation rate of 64% in NF2 patients, in contrast to 98% in non-NF2 patients. In the study of Andrews et al, 21 the tumor control rate after FSRT was lower in NF2 patients than in non-NF2 patients (67% and 97%, respectively). In contrast, Chan et al 6 observed no difference in tumor control and hearing preservation between NF2 and non-NF2 patients.…”

Section: Discussionmentioning

confidence: 85%

“…6,21,[32][33][34] Combs et al 33 reported that an actuarial 5-year local tumor control rate was 93% after FSRT. Interestingly, NF2 was significantly associated with adverse outcomes in this study, with an actuarial 5-year hearing preservation rate of 64% in NF2 patients, in contrast to 98% in non-NF2 patients.…”

Section: Discussionmentioning

confidence: 99%

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Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Phi¹,

Kim²,

Chung³

et al. 2009

Cancer

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BACKGROUND:The radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2 (NF2) is controversial. The authors investigated the radiologically proven tumor control rate after gamma knife radiosurgery. The factors that affect tumor control and serviceable hearing preservation were analyzed.METHODS:Thirty‐six lesions in 30 patients were included. The median lengths of the clinical and radiologic follow‐ups were 48.5 months and 36.5 months, respectively. The median tumor volume was 3.2 cm3. The mean marginal dose was 12.1 grays (Gy) (range, 8–14 Gy) at an isodose line of 50%±0.6%. The Kaplan‐Meier method and Cox proportional hazards model were used for the statistical analyses.RESULTS:The actuarial tumor control rate was 81%, 74%, and 66%, respectively, in the first, second, and fifth years. Five tumors required a salvage surgery because of tumor control failure. A low marginal dose and a young age at radiosurgery were associated with poor tumor control. Of the 16 tumors with which ipsilateral hearing was serviceable, the actuarial serviceable hearing preservation rates were 50%, 45%, and 33%, respectively, in the first, second, and fifth years. Better ipsilateral hearing (Gardner‐Robertson grade 1, compared with grade 2) at the time of radiosurgery was associated with significantly greater serviceable hearing preservation.CONCLUSIONS:Gamma knife radiosurgery for vestibular schwannomas in NF2 patients provided 5‐year tumor control in approximately two‐thirds of patients and preserved serviceable hearing in approximately one‐third. The rates of other cranial nerve deficits were low, and no secondary malignancy was observed. Radiosurgery should be included in treatment options for NF2 patients. Cancer 2009. © 2009 American Cancer Society.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 85%

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Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Phi¹,

Kim²,

Chung³

et al. 2009

Cancer

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“…3,[25][26][27] Stereotactic radiosurgery (SRS), utilizing either a linac or GK-based system approach, is a noninvasive alternative to surgery, with comparable local control rates demonstrated. 9,[28][29][30][31] Due to the close proximity of most tumors to the brainstem, the risks of cranial nerve dysfunction secondary to marginal doses have resulted in initially higher complication rates with SRS, 29,30 although these have now decreased over recent years concomitant with reduction in the total dose prescribed, improved expertise, and better patient selection. 8,32,33 FSRT for AN remains a viable, radiotherapeutic alternative, achieving comparable local control rates to both microsurgery and SRS, and with comparable morbidity in modern series.…”

Section: Discussionmentioning

confidence: 99%

Fractionated stereotactic radiotherapy for acoustic neuroma

Koh

Millar

Ménard

et al. 2007

Cancer

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BACKGROUND.The clinical outcome and toxicity of fractionated stereotactic radiotherapy (FSRT) was assessed for acoustic neuroma in 60 patients treated in a single institution.METHODS.Between October 1996 and February 2005, 60 patients received FSRT for acoustic neuroma (AN). The mean total dose applied was 50 Gy in single daily 2‐Gy fractions over 5 weeks. The median irradiated tumor volume was 4.9 cm3 (range, 0.3–49.0 cm3). The median follow‐up period was 31.9 months.RESULTS.FSRT was well tolerated in all patients. The 5‐year actuarial local control rate was 96.2% (95% CI: 91.1%–100.0%). Five‐year actuarial progression‐free survival was 92.8% (95% CI: 84.8%–100.0%). The overall hearing preservation rate was 77.3%. Five of 6 patients with initial cranial nerve V (CNV) numbness remained stable post‐FSRT. Two of 3 patients with baseline trigeminal neuralgia improved with the remaining patient stable. All 3 patients with nonsurgically related facial nerve weakness either improved or achieved stability in function. There were no cases of new cranial nerve toxicity post‐FSRT.CONCLUSIONS.FSRT for the treatment of AN is safe, effective, and well tolerated. FSRT should thus be considered as an effective alternative treatment modality when compared with microsurgical resection or single fraction stereotactic radiosurgery. Cancer 2007. © 2007 American Cancer Society.

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“…27,28 Meijer et al 29 in the Netherlands prospectively evaluated 129 patients with vestibular schwannomas who received either 20 to 25 Gy in 4 to 5 fractions if they were dentate (80 patients) versus 10 to 12.5 Gy in a single fraction if they were edentate (49 patients). This study revealed a four-fold increase in cranial nerve V complications with single fraction radiosurgery compared with fractionated radiation (8% vs 2%).…”

Section: Mri-guided Therapymentioning

confidence: 99%

Radiation Techniques in Neuro-Oncology

Khuntia

Mehta

2009

Neurotherapeutics

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Summary: Radiation therapy plays a critical role in the management of tumors of the brain. A variety of radiotherapy techniques have been used to treat these tumors. This review describes both classic and more recent and advanced techniques available to manage these tumors. Included is a discussion of standard two-and three-dimensional radiation, as well as intensity-modulated radiotherapy, image-guided radiation therapy, stereotactic radiosurgery, and heavy particles.

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Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution

Cited by 308 publications

References 76 publications

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Radiosurgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Fractionated stereotactic radiotherapy for acoustic neuroma

Radiation Techniques in Neuro-Oncology

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