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Long-term outcomes of patients with primary or residual vestibular schwannoma treated with LINAC-based stereotactic radiosurgery: a single-centre experience

Published online by Cambridge University Press:  07 August 2020

Patricia Sebastian Open the ORCID record for Patricia Sebastian [Opens in a new window] ,
Subhashini John ,
Jebakarunya Reddy ,
Sunitha Susan Varghese ,
Harshad Arvind Vanjare ,
Ranjith K. Moorthy ,
Krishna Prabhu  and
Bijesh Yadav
Patricia Sebastian*
Affiliation:
Department of Radiation Oncology, Christian Medical College, Vellore, India
Subhashini John
Affiliation:
Department of Radiation Oncology, Christian Medical College, Vellore, India
Jebakarunya Reddy
Affiliation:
Department of Radiation Oncology, Christian Medical College, Vellore, India
Sunitha Susan Varghese
Affiliation:
Department of Radiation Oncology, Christian Medical College, Vellore, India
Harshad Arvind Vanjare
Affiliation:
Department of Radiology, Christian Medical College, Vellore, India
Ranjith K. Moorthy
Affiliation:
Department of Neurosciences and Neurosurgery, Christian Medical College, Vellore, India
Krishna Prabhu
Affiliation:
Department of Neurosciences and Neurosurgery, Christian Medical College, Vellore, India
Bijesh Yadav
Affiliation:
Department of Biostatistics, Christian Medical College, Vellore, India
*
Author for correspondence: Patricia Sebastian, Associate Professor, Department of Radiation Oncology, Christian Medical College, Vellore632004, India. Tel: +919443097564. E-mail: [email protected]
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Abstract

Aim:

Vestibular schwannomas (VS) are benign slow-growing tumours treated either with microsurgery or stereotactic radiosurgery (SRS) or both. The aim of this study was to correlate the outcome factors—tumour control and adverse factors—facial nerve function and hearing loss with patient and treatment factors.

Materials and methods:

A retrospective review of the records of 98 patients with 99 VS treated from June 2007 to June 2014, all patients receiving Linear Accelerator (LINAC)-based SRS.

Results:

Median follow-up period was 5·6 years (range: 1–12 years). The response to treatment was stable disease in 37 (37·4%), regression in 46 (46·5%), asymptomatic minimal progression in 9 (9·1%) and symptomatic progression in 5 (5%) and unknown in 2 (2%) patients. There was no evidence of SRS induced tissue damage on magnetic resonance scans for any. Hearing preservation rate after SRS was 92%. The patients who developed worsening of facial function were predominantly in the cohort that had prior surgery.

Findings:

SRS is an effective modality to treat VS lesser than 3 cm in size. Tumour control rate was 95% with a median follow-up period of 5·6 years. The complication rates were 8% each for facial function worsening and worsening of hearing. Prior surgery was a statistically significant factor that affected facial nerve function deterioration.

Keywords

Vestibular schwannomastereotactic radiosurgeryLINAC based
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 4 , December 2021 , pp. 426 - 432
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Massager, N, Nissim, O, Delbrouck, C, et al. Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery. Int J Radiat Oncol Biol Phys 2006; 64 (5): 1331–1340.10.1016/j.ijrobp.2005.10.030CrossRefGoogle ScholarPubMed
Mallory, GW, Pollock, BE, Foote, RL, Carlson, ML, Driscoll, CL, Link, MJ. Stereotactic radiosurgery for neurofibromatosis 2—associated vestibular schwannomas: toward dose optimization for tumor control and functional outcomes. Neurosurgery 2014; 74 (3): 292–301.10.1227/NEU.0000000000000264CrossRefGoogle ScholarPubMed
Kondziolka, D, Lunsford, LD, McLaughlin, MR, Flickinger, JC. Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 1998; 339 (20): 1426–1433.10.1056/NEJM199811123392003CrossRefGoogle ScholarPubMed
Ikonomidis, C, Pica, A, Bloch, J, Maire, R. Vestibular schwannoma: the evolution of hearing and tumor size in natural course and after treatment by LINAC stereotactic radiosurgery. Audiol Neurotol 2015; 20 (6): 406–415.10.1159/000441119CrossRefGoogle ScholarPubMed
Berkowitz, O, Iyer, AK, Kano, H, Talbott, EO, Lunsford, LD. Epidemiology and environmental risk factors associated with vestibular schwannoma. World Neurosurg 2015; 84 (6): 1674–1680.10.1016/j.wneu.2015.07.007CrossRefGoogle ScholarPubMed
Murphy, ES, Suh, JH. Radiotherapy for vestibular schwannomas: a critical review. Int J Radiat Oncol 2011; 79 (4): 985–997.10.1016/j.ijrobp.2010.10.010CrossRefGoogle ScholarPubMed
Wolbers, JG, Dallenga, AH, Mendez Romero, A, van Linge, A. What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open 2013; 3 (2): e001345–e001345.10.1136/bmjopen-2012-001345CrossRefGoogle ScholarPubMed
Kalogeridi, M-A, Georgolopoulou, P, Kouloulias, V, Kouvaris, J, Pissakas, G. Long-term results of LINAC-based stereotactic radiosurgery for acoustic neuroma: The Greek experience. J Cancer Res Ther 2009; 5 (1): 8–13.10.4103/0973-1482.48764CrossRefGoogle ScholarPubMed
Badakhshi, H, Graf, R, Bohmer, D, Synowitz, M, Wiener, E, Budach, V. Results for local control and functional outcome after linac-based image-guided stereotactic radiosurgery in 190 patients with vestibular schwannoma. J Radiat Res (Tokyo) 2014; 55 (2): 288–292.10.1093/jrr/rrt101CrossRefGoogle ScholarPubMed
Rutten, I, Baumert, BG, Seidel, L, et al. Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma. Radiother Oncol J 2007; 82 (1): 83–89.10.1016/j.radonc.2006.11.019CrossRefGoogle ScholarPubMed
Lunsford, LD, Niranjan, A, Flickinger, JC, Maitz, A, Kondziolka, D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005; 102 (Suppl): 195–199.10.3171/sup.2005.102.s_supplement.0195CrossRefGoogle ScholarPubMed
Spiegelmann, R, Lidar, Z, Gofman, J, Alezra, D, Hadani, M, Pfeffer, R. Linear accelerator radiosurgery for vestibular schwannoma. J Neurosurg 2001; 94 (1): 7–13.10.3171/jns.2001.94.1.0007CrossRefGoogle ScholarPubMed
Santacroce, A, Kamp, MA, Budach, W, Hänggi, D. Radiobiology of radiosurgery for the central nervous system. BioMed Res Int 2013; 2013: 362761.CrossRefGoogle ScholarPubMed
Flickinger, JC. What is the optimal dose and fractionation for stereotactic irradiation of acoustic neuromas? Int J Radiat Oncol Biol Phys 2002; 54 (2): 311–312.CrossRefGoogle ScholarPubMed
Singh, M. Surgery for vestibular schwannoma following stereotactic radiosurgery. Neurol India 2019; 67 (5): 1279.CrossRefGoogle ScholarPubMed
Hsu, P-W, Chang, C-N, Lee, S-T, et al. Outcomes of 75 patients over 12 years treated for acoustic neuromas with linear accelerator-based radiosurgery. J Clin Neurosci 2010; 17 (5): 556–560.CrossRefGoogle ScholarPubMed
Roos, DE, Potter, AE, Brophy, BP. Stereotactic radiosurgery for acoustic neuromas: what happens long term? Int J Radiat Oncol Biol Phys 2012; 82 (4): 1352–1355.CrossRefGoogle ScholarPubMed
Choy, W, Spasic, M, Pezeshkian, P, et al. Outcomes of stereotactic radiosurgery and stereotactic radiotherapy for the treatment of vestibular schwannoma. Neurosurgery 2013; 60 (Suppl. 1): 120–125.CrossRefGoogle ScholarPubMed
Puataweepong, P, Dhanachai, M, Dangprasert, S, et al. Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas: comparative observations of 139 patients treated at a single institution. J Radiat Res (Tokyo) 2014; 55 (2): 351–358.10.1093/jrr/rrt121CrossRefGoogle ScholarPubMed
Anderson, BM, Khuntia, D, Bentzen, SM, et al. Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery. J Neurooncol 2014; 116 (1): 187–193.10.1007/s11060-013-1282-4CrossRefGoogle ScholarPubMed
Ellenbogen, JR, Waqar, M, Kinshuck, AJ, et al. Linear accelerator radiosurgery for vestibular schwannomas: results of medium-term follow-up. Br J Neurosurg 2015; 29 (5): 678–684.10.3109/02688697.2015.1036837CrossRefGoogle ScholarPubMed
Windisch, PY, Tonn, J-C, Fürweger, C, et al. Clinical results after single-fraction radiosurgery for 1,002 vestibular schwannomas. Cureus 2019; 11 (12): e6390.Google ScholarPubMed
Ding, K, Ng, E, Romiyo, P, et al. Meta-analysis of tumor control rates in patients undergoing stereotactic radiosurgery for cystic vestibular schwannomas. Clin Neurol Neurosurg 2020; 188: 105571.10.1016/j.clineuro.2019.105571CrossRefGoogle ScholarPubMed
Okunaga, T, Matsuo, T, Hayashi, N, et al. Linear accelerator radiosurgery for vestibular schwannoma: measuring tumor volume changes on serial three-dimensional spoiled gradient-echo magnetic resonance images. J Neurosurg 2005; 103 (1): 53–58.10.3171/jns.2005.103.1.0053CrossRefGoogle ScholarPubMed
van de Langenberg, R, Dohmen, AJC, de Bondt, BJ, Nelemans, PJ, Baumert, BG, Stokroos, RJ. Volume Changes After Stereotactic LINAC Radiotherapy in Vestibular Schwannoma: Control Rate and Growth Patterns. Int J Radiat Oncol 2012; 84 (2): 343–349.CrossRefGoogle ScholarPubMed
Walker, AJ, Ruzevick, J, Malayeri, AA, et al. Postradiation imaging changes in the CNS: how can we differentiate between treatment effect and disease progression? Future Oncol Lond Engl 2014; 10 (7): 1277–1297.CrossRefGoogle ScholarPubMed
Linskey, ME, Flickinger, JC, Lunsford, LD. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 1993; 25 (2): 227–233.CrossRefGoogle ScholarPubMed
Leon, J, Lehrer, EJ, Peterson, J, et al. Observation or stereotactic radiosurgery for newly diagnosed vestibular schwannomas: a systematic review and meta-analysis. J Radiosurgery SBRT 2019; 6 (2): 91–100.Google ScholarPubMed
Persson, O, Bartek, J, Shalom, NB, Wangerid, T, Jakola, AS, Förander, P. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. Acta Neurochir (Wien). 2017; 159 (6): 1013–1021.10.1007/s00701-017-3164-6CrossRefGoogle ScholarPubMed
Lerner, DK, Lee, D, Naples, JG, et al. Factors associated with facial nerve paresis following gamma knife for vestibular schwannoma. Otol Neurotol 2020; 41 (1): e83–e83.10.1097/MAO.0000000000002401CrossRefGoogle ScholarPubMed
Deora, H, Tripathi, M. Hearing loss after radiosurgery-blame it on Cochlear dose or the radiation tool! Radiat Oncol Lond Engl 2019; 14 (1): 186.10.1186/s13014-019-1390-1CrossRefGoogle ScholarPubMed