Transient expansion of vestibular schwannoma following stereotactic radiosurgery

Nagano, Osamu; Higuchi, Yoshinori; Serizawa, Toru; Ono, Junichi; Matsuda, Shinji; Yamakami, Iwao; Saeki, Naokatsu

doi:10.3171/jns/2008/109/11/0811

Cited by 133 publications

(119 citation statements)

References 27 publications

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“…Overall, tumor response was comparable to published results [1,[9][10][11][12][13][14][15][16] with 94 % of tumors being controlled. However, there was a significant proportion of patients (39 %) who demonstrated transient increases in tumor volume on MRI, or "pseudoprogression" before eventual tumor regression.…”

Section: Discussionsupporting

confidence: 84%

“…This phenomenon is well recognized to occur in patients with gliomas treated with fractionated radiation therapy [17]. More recently, several reports have emerged demonstrating transient tumor volume increases in VS treated with stereotactic radiosurgery [8,[13][14][15][16]. To our knowledge, there is only one other report in the literature by Shirato et al of transient tumor volume increases after fractionated radiation therapy for VS [13].…”

Section: Discussionmentioning

confidence: 99%

“…The phenomenon of "pseudoprogression" or transient increases in tumor volume that mimic tumor progression but are due to treatment effect has been observed in patients with VS treated with radiation [8,[13][14][15][16]. We conducted an institutional study to report the presence and impact of pseudoprogression in VS treated with fractionated stereotactic radiation.…”

Section: Introductionmentioning

confidence: 99%

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Pseudoprogression of vestibular schwannomas after fractionated stereotactic radiation therapy

et al. 2012

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Objectives Local tumor control after radiation of vestibular schwannomas (VS) is assessed by follow-up magnetic resonance imaging (MRI) of the brain. Transient increases in tumor volume on MRI due to radiation can mimic tumor progression but are related to radiation treatment effects known as "pseudoprogression". Our study aims to determine the presence and impact of pseudoprogression in VS patients treated with fractionated stereotactic radiotherapy. Methods We analyzed 18 patients with VS treated with fractionated radiotherapy with at least 24 months of follow-up with T1-weighted gadolinium-enhanced MRIs. Mean follow-up time was 42 months. Pre-and posttreatment tumor volumes were calculated using OsiriX® software. Events were defined as volume changes ≥10 %. Results Tumor control rate was 94 %. Forty-four percent of tumors demonstrated increases in volume on follow-up, but all but one patient had transient increases in volume with subsequent regression. Mean tumor volume increased by 35 % with the average time to regression of 24 months. Adverse side effects were more frequent in patients demonstrating pseudoprogression. There were no differences in outcomes based on pre-treatment tumor size or cystic-type versus solid-type tumors. Conclusions Fractionated stereotactic radiation therapy is an effective treatment for VS. Follow-up imaging with T1-weighted gadolinium-enhanced MRI demonstrated pseudoprogression in a third of patients occurring up to 36 months post-treatment before regression. Therefore, repeat imaging and clinical follow-up of VS should be done to rule out pseudoprogression and avoid unnecessary salvage treatment.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pseudoprogression of vestibular schwannomas after fractionated stereotactic radiation therapy

et al. 2012

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“…Although an association between transient volume expansion and cranial nerve (5th or 7th) dysfunction was reported in several studies, the correlation between transient volume expansion and hearing deterioration remains controversial [9,11,21] . Nagano et al [21] and van Eck and Horstmann [6] reported that transient volume expansion was observed in more than half of their patients within 1 year; however, this did not correlate significantly with hearing deterioration. In contrast, Wowra et al [9] reported that risk of hearing loss was significantly correlated with transient tumor swelling.…”

Section: Prognostic Factors Of Hearing Preservationmentioning

confidence: 99%

“…that we should accept the 6 25% increase as a significant value of transient volume expansion since a volume change of 6 10% may result from error of calculation [9,11,21] . Although an association between transient volume expansion and cranial nerve (5th or 7th) dysfunction was reported in several studies, the correlation between transient volume expansion and hearing deterioration remains controversial [9,11,21] .…”

Section: Prognostic Factors Of Hearing Preservationmentioning

confidence: 99%

Efficacy of Corticosteroids in Hearing Preservation after Radiosurgery for Vestibular Schwannoma: A Prospective Study

Kim

Paek

et al. 2010

Stereotact Funct Neurosurg

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Objectives: We prospectively investigated the efficacy of corticosteroid medication in salvaging acute hearing deterioration after radiosurgery for vestibular schwannoma (VS) and analyzed prognostic factors for hearing preservation. Methods: Forty-one patients with serviceable hearing treated with gamma knife radiosurgery between 2004 and 2006 were included. Nineteen patients who suffered acute hearing deterioration after radiosurgery were treated with oral corticosteroids. The efficacy of corticosteroids was compared with the results of a historical observation group of 15 patients who had experienced hearing deterioration but who had not taken corticosteroids. Results: The tumor control rate and serviceable hearing preservation rate at the last follow-up were 97.6 and 61%, respectively. There was no significant difference in the actuarial serviceable hearing preservation rates between the corticosteroid treatment group and the historical observation group (p = 0.519). However, the mean pure-tone averages were significantly different between the 2 groups (51.5 vs. 63.7 dB; p = 0.025). Multivariate analysis revealed that preradiosurgery hearing status and transient volume expansion were prognostic factors for hearing preservation (p = 0.013 and p = 0.029, respectively). Conclusions: This study demonstrates the possibility that corticosteroid medication may improve acute hearing deterioration after radiosurgery in VS patients. Further studies on optimal corticosteroid medication for managing acute hearing deterioration after radiosurgery are mandatory.

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Hearing preservation after stereotactic radiosurgery for sporadic intracanalicular vestibular schwannomas classified as Koos grade 1

Kang,

Ji,

Kim

et al. 2024

Cancer Medicine

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IntroductionThe mechanism of hearing loss following stereotactic radiosurgery (SRS) for vestibular schwannomas (VSs) remains unclear. There is conflicting evidence regarding cochlear nerve damage by transient volume expansion of VSs after radiosurgery and radiation‐induced cochlear damage. This study aimed to investigate whether there is a specific patient population that can achieve definite hearing preservation after SRS for VSs.MethodsA total of 37 consecutive patients with sporadic unilateral intracanalicular VSs and serviceable hearing (Gardner‐Roberson [G‐R] class I or II) were treated with SRS from 2009 to 2023. This is a retrospective study. Survival analysis with Cox regression for hearing deterioration was performed.ResultsThe median age was 55 years old. The median tumor volume was 0.089 cm3, and the median marginal dose was 12.0 Gy. Nonserviceable hearing deterioration occurred in 9 patients (24.3%), with a median onset of 11.9 months after SRS. The actuarial rates of serviceable hearing preservation were 86%, 82%, and 70% at 1, 2, and 3 years after SRS, respectively. In a multivariate analysis, only baseline pure tone average > 30 dB increased the risk of nonserviceable hearing deterioration with significant hazard ratio. There were 13 patients with petit VSs whose tumor volume was smaller than 0.05 cm3, and 11 of them were treated by a 4‐mm single shot with a marginal dose of 12 Gy. None of the 13 patients had nonserviceable hearing deterioration.ConclusionsPetit VSs that can be treated with 4‐mm single or double shots with a marginal dose of 12 Gy may achieve hearing preservation after SRS.

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Transient expansion of vestibular schwannoma following stereotactic radiosurgery

Abstract: Transient expansion of VSs after GKS was found to be much more frequent than previously reported, strongly suggesting a correlation with deterioration of facial and trigeminal nerve functions.

Cited by 133 publications

References 27 publications

Pseudoprogression of vestibular schwannomas after fractionated stereotactic radiation therapy

Pseudoprogression of vestibular schwannomas after fractionated stereotactic radiation therapy

Efficacy of Corticosteroids in Hearing Preservation after Radiosurgery for Vestibular Schwannoma: A Prospective Study

Hearing preservation after stereotactic radiosurgery for sporadic intracanalicular vestibular schwannomas classified as Koos grade 1

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