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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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