Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

Dumot, Chloé; Pikis, Stylianos; Mantziaris, Georgios; Xu, Zhiyuan; Dayawansa, Sam; Anand, Rithika Kormath; Nabeel, Ahmed M; Sheehan, Darrah; Sheehan, Kimball; Reda, Wael A; Tawadros, Sameh R; Karim, Khaled Abdel; El-Shehaby, Amr M N; Eldin, Reem M Emad; Peker, Selçuk; Samancı, Yavuz; Kaisman-Elbaz, Tehila; Speckter, Herwin; Hernández, Wenceslao; Isidor, Julio; Tripathi, Manjul; Madan, Renu; Zacharia, Brad E.; Daggubati, Lekhaj C.; Moreno, Nuria Martínez; Álvarez, Roberto Martínez; Langlois, Anne-Marie; Mathieu, David; Deibert, Christopher P.; Sudhakar, Vivek; Cifarelli, Christopher P.; Icaza, Denisse Arteaga; Cifarelli, Daniel T; Wei, Zhishuo; Niranjan, Ajay; Barnett, Gene H.; Lunsford, L. Dade; Bowden, Gregory; Sheehan, Jason P.

doi:10.1007/s00701-022-05454-w

Cited by 8 publications

(3 citation statements)

References 43 publications

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“…Data supporting SRS for VS in the latter setting are limited, but an increasing number of studies have been published in recent years supporting its use. [11][12][13][14][15][16][17][18] Our study FIGURE 2. Estimation of brainstem compression and contact from vestibular schwannoma.…”

Section: Discussionmentioning

confidence: 64%

“…While surgery is clearly indicated when the VS is causing serious symptoms related to mass effect, the best treatment in the absence of these symptoms is less clear. Data supporting SRS for VS in the latter setting are limited, but an increasing number of studies have been published in recent years supporting its use 11–18 . Our study distinguishes itself from existing studies in the following ways: 1) patients were treated with linac-based SRS, usually to the 70% isodose line, as opposed to the 50% isodose line with GK; 2) we did not limit the population based on tumor size, so long as there was radiographic evidence of brainstem compression at the time of SRS; and 3) we describe brainstem DVH parameters in the context of TG101 constraints.…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression

De Leo,

Shah,

et al. 2023

American Journal of Clinical Oncology

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Objective: The safety of single-treatment stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) with radiographic evidence of brainstem compression but without motor deficit is controversial. Data on linear accelerator (linac)-based SRS in this setting are scarce. We address this with an outcomes report from an unselected series of patients with VS with radiographic brainstem compression treated with linac SRS. Methods: We included 139 patients with unilateral VS (any size) with radiographic brainstem compression (all without serious brainstem neurological deficits). The SRS prescription dose was 12.5 Gy (single fraction) using 6MV linac-produced photon beams, delivered with a multiple arc technique. Inclusion criteria required at least 1 year of radiographic follow-up with magnetic resonance imaging. The primary endpoint was freedom from serious brainstem toxicity (≥grade 3 Common Terminology Criteria for Adverse Events v5); the secondary was freedom from enlargement (tumor progression or any requiring intervention). We assessed serious cranial nerve complications, excluding hearing loss, defined as Common Terminology Criteria for Adverse Events v5 grade 3 toxicity. Results: Median magnetic resonance imaging follow-up time was 5 years, and median tumor size was 2.5 cm in greatest axial dimension and 5 ml in volume. The median brainstem D0.03 ml=12.6 Gy and median brainstem V10 Gy=0.4 ml. At 5 years, the actuarial freedom from serious brainstem toxicity was 100%, and freedom from tumor enlargement (requiring surgery and/or due to progression) was 90%. Severe facial nerve damage in patients without tumor enlargement was 0.9%. Conclusion: Linac-based SRS, as delivered in our series for VS with radiographic brainstem compression, is safe and effective.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression

De Leo,

Shah,

et al. 2023

American Journal of Clinical Oncology

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“…In this study, the authors found that the local tumor control rate was high, with 96% and 86.2% at 5 and 10 years, respectively. 14 The serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively, and the facial nerve function preservation or improvement rate was 98.7% and 91% at 5 and 10 years, respectively. In addition, in a multi-institutional study of 627 Koos grade IV VSs (median age: 54 years) treated with SRS, Pikis et al 15 reported a 92.3% 5-year tumor control rate.…”

Section: Discussionmentioning

confidence: 86%

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

et al. 2023

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BACKGROUND AND OBJECTIVES: The management of octogenarians with vestibular schwannomas (VS) has received little attention. However, with the increase in octogenarian population, more effort is needed to clarify the value of stereotactic radiosurgery (SRS) in this population. The aim of this study was to evaluate the safety and efficacy of SRS in this patient age group. METHODS: A retrospective study of 62 patients aged 80 years or older who underwent single-session SRS for symptomatic VS during a 35-year interval was performed. The median patient age was 82 years, and 61.3% were male. SRS was performed as planned adjuvant management or for delayed progression after prior partial resection in 5 patients. RESULTS: SRS resulted in a 5-year tumor control rate of 95.6% with a 4.8% risk of adverse radiation effects (ARE). Tumor control was unrelated to patient age, tumor volume, Koos grade, sex, SRS margin dose, or prior surgical management. Four patients underwent additional management including 1 patient with symptomatic progression requiring surgical resection, 2 patients with symptomatic hydrocephalus requiring cerebrospinal fluid diversion, and 1 patient whose tumor-related cyst required delayed cyst aspiration. Three patients developed ARE, including 1 patient with permanent facial weakness (House-Brackmann grade II), 1 who developed trigeminal neuropathy, and 1 who had worsening gait disorder. Six patients had serviceable hearing preservation before SRS, and 2 maintained serviceable hearing preservation after 4 years. A total of 44 (71%) patients died at an interval ranging from 6 to 244 months after SRS. CONCLUSION: SRS resulted in tumor and symptom control in most octogenarian patients with VS.

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Stereotactic radiosurgery for Koos grade IV vestibular schwannoma: a systematic review and meta-analysis

Szymoniuk,

Kochański,

Wilk

et al. 2024

Acta Neurochir

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Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

Cited by 8 publications

References 43 publications

Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression

Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

Stereotactic radiosurgery for Koos grade IV vestibular schwannoma: a systematic review and meta-analysis

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