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Long-term beneficial outcome of fractionated stereotactic radiotherapy for smaller and larger vestibular schwannomas

Published online by Cambridge University Press:  08 May 2017

Zjiwar H. A. Sadik ,
Alejandra Mendez Romero ,
Anne van Linge ,
Alof H. G. Dallenga ,
Robert-Jan Pauw  and
John G. Wolbers
Zjiwar H. A. Sadik*
Affiliation:
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
Alejandra Mendez Romero
Affiliation:
Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
Anne van Linge
Affiliation:
Department of Otolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
Alof H. G. Dallenga
Affiliation:
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
Robert-Jan Pauw
Affiliation:
Department of Otolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
John G. Wolbers
Affiliation:
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
*
Correspondence to: Zjiwar H. A. Sadik, Erasmus MC, Rotterdam, Zuid-Holland, 3015 CE, The Netherlands. Tel: +31 64 494 0527. E-mail: [email protected]
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Abstract

Background and purpose

Fractionated stereotactic radiotherapy (FSRT) is an alternative treatment for large vestibular schwannomas (VS), if patients are not fit for or refuse surgery. In this study, we compared long-term clinical and radiological outcome in both small–medium sized and larger tumours.

Material and methods

A retrospective study was performed of patients with sporadic VS who underwent primarily conventional FSRT. In total, 50 consecutive patients were divided into two groups by volume. Clinical and volumetric parameters were analysed.

Results

In all, 41 patients (82%) had large tumours affecting the 4th ventricle (modified Koos stage 4). Definitive expansion of VS occurred in eight out of 50 patients (16%). After 7·2 years (median) the overall freedom from clinical failure was 100% in smaller and 92% in larger schwannomas (arbitrarily sized >7·4 cc). Useful hearing was preserved in only 35% of the patients. The facial nerve remained intact in all cases, while new deficit of the trigeminal nerve occurred in 20% of the cases. Of the larger tumours 20% needed a cerebrospinal fluid (CSF) shunt.

Conclusions

FSRT is a treatment in its own right as it is highly effective in both smaller and larger VS without causing permanent disabling complications. The outcome is beneficial also in larger tumours that affect the 4th ventricle.

Keywords

acoustic neuromafractionated stereotactic radiotherapyvestibular schwannoma
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 4 , December 2017 , pp. 451 - 460
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Copyright
© Cambridge University Press 2017 

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References

1. Smouha, E E, Yoo, M, Mohr, K, Davis, R P. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope 2005; 115: 450–454.Google Scholar
2. Yoshimoto, Y. Systematic review of the natural history of vestibular schwannoma. J Neurosurg 2005; 103: 59–63.Google Scholar
3. Hajioff, D, Raut, V V, Walsh, R M et al. Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 2008; 33: 255–259.Google Scholar
4. Nikolopoulos, T P, Fortnum, H, O’Donoghue, G, Baguley, D. Acoustic neuroma growth: a systematic review of the evidence. Otol Neurotol 2010; 31: 478–485.Google Scholar
5. Stangerup, S E, Caye-Thomasen, P, Tos, M, Thomsen, J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27: 547–552.Google Scholar
6. Lanser, M J, Sussman, S A, Frazer, K. Epidemiology, pathogenesis, and genetics of acoustic tumors. Otolaryngol Clin North Am 1992; 25: 499–520.Google Scholar
7. Tos, M, Stangerup, S E, Caye-Thomasen, P, Tos, T, Thomsen, J. What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg 2004; 130: 216–220.Google Scholar
8. Lin, D, Hegarty, J L, Fischbein, N J, Jackler, R K. The prevalence of ‘incidental’ acoustic neuroma. Arch Otolaryngol Head Neck Surg 2005; 131: 241–244.Google Scholar
9. Wolbers, J G, Dallenga, A H, Mendez Romero, A, van Linge, A. What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open 2013; 3 e001345. doi: 10.1136/bmjopen-2012-001345.Google Scholar
10. Murphy, E S, Suh, J H. Radiotherapy for vestibular schwannomas: a critical review. Int J Radiat Oncol Biol Phys 2011; 79: 985–997.CrossRefGoogle ScholarPubMed
11. Jian, B J, Kaur, G, Sayegh, E T, Bloch, O, Parsa, A T, Barani, I J. Fractionated radiation therapy for vestibular schwannoma. J Clin Neurosci 2014; 21: 1083–1088.Google Scholar
12. House, J W, Brackmann, D E. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93: 146–147.Google Scholar
13. Monsell, E M, Balkany, T A, Gates, G A, Goldenberg, R A, Meyerhoff, W L, House, J W. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113: 179–180.Google Scholar
14. Kanzaki, J, Tos, M, Sanna, M, Moffat, D A, Monsell, E M, Berliner, K I. New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003; 24: 642–648, discussion 648–649.CrossRefGoogle ScholarPubMed
15. Koos, W T, Bock, F W. Experiences with the microneurosurgical treatment of bilateral acoustic tumors. Neurochirurgia 1972; 15: 159–166.Google ScholarPubMed
16. Dombi, E, Ardern-Holmes, S L, Babovic-Vuksanovic, D et al. Recommendations for imaging tumor response in neurofibromatosis clinical trials. Neurology 2013; 81: S33–S40.Google Scholar
17. Harris, G J, Plotkin, S R, Maccollin, M et al. Three-dimensional volumetrics for tracking vestibular schwannoma growth in neurofibromatosis type II. Neurosurgery 2008; 62: 1314–1319, discussion 1319–1320.Google Scholar
18. Vokurka, E A, Herwadkar, A, Thacker, N A, Ramsden, R T, Jackson, A. Using Bayesian tissue classification to improve the accuracy of vestibular schwannoma volume and growth measurement. Am J Neuroradiol 2002; 23: 459–467.Google Scholar
19. Walz, P C, Bush, M L, Robinett, Z, Kirsch, C F, Welling, D B. Three-dimensional segmented volumetric analysis of sporadic vestibular schwannomas: comparison of segmented and linear measurements. Otolaryngol Head Neck Surg 2012; 147: 737–743.Google Scholar
20. Chan, A W, Black, P, Ojemann, R G et al. Stereotactic radiotherapy for vestibular schwannomas: favorable outcome with minimal toxicity. Neurosurgery 2005; 57: 60–70, discussion 60–70.Google Scholar
21. Sawamura, Y, Shirato, H, Sakamoto, T et al. Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 2003; 99: 685–692.Google Scholar
22. Rasmussen, R, Claesson, M, Stangerup, S E et al. Fractionated stereotactic radiotherapy of vestibular schwannomas accelerates hearing loss. Int J Radiat Oncol Biol Phys 2012; 83: e607–e611.Google Scholar
23. Carlson, M L, Jacob, J T, Pollock, B E et al. Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline. J Neurosurg 2013; 118: 579–587.Google Scholar
24. Yu, C P, Cheung, J Y, Leung, S, Ho, R. Sequential volume mapping for confirmation of negative growth in vestibular schwannomas treated by gamma knife radiosurgery. J Neurosurg 2000; 93 (suppl 3): 82–89.Google Scholar
25. Nagano, O, Higuchi, Y, Serizawa, T et al. Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 2008; 109: 811–816.Google Scholar
26. Pollock, B E. Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery 2006; 58: 241–248, discussion 241–248.Google Scholar