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Multisession Stereotactic Radiosurgery for Vestibular Schwannomas: Single-Institution Experience With 383 Cases
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Multisession Stereotactic Radiosurgery for Vestibular Schwannomas: Single-Institution Experience With 383 Cases
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Journal Article
Multisession Stereotactic Radiosurgery for Vestibular Schwannomas: Single-Institution Experience With 383 Cases
2011
Overview
Abstract
BACKGROUND
Single-session stereotactic radiosurgery (SRS) treatment of vestibular schwannomas results in excellent tumor control. It is not known whether functional outcomes can be improved by fractionating the treatment over multiple sessions.
OBJECTIVE
To examine tumor control and complication rates after multisession SRS.
METHODS
Three hundred eighty-three patients treated with SRS from 1999 to 2007 at Stanford University Medical Center were retrospectively reviewed. Ninety percent were treated with 18 Gy in 3 sessions, targeting a median tumor volume of 1.1 cm3 (range, 0.02-19.8 cm3).
RESULTS
During a median follow-up duration of 3.6 years (range, 1-10 years), 10 tumors required additional treatment, resulting in 3- and 5-year Kaplan-Meier tumor control rates of 99% and 96%, respectively. Five-year tumor control rate was 98% for tumors > 3.4 cm3. Neurofibromatosis type 2–associated tumors were associated with worse tumor control (P = .02). Of the 200 evaluable patients with pre-SRS serviceable hearing (Gardner-Robertson grade 1 and 2), the crude rate of serviceable hearing preservation was 76%. Smaller tumor volume was associated with hearing preservation (P = .001). There was no case of post-SRS facial weakness. Eight patients (2%) developed trigeminal dysfunction, half of which was transient.
CONCLUSION
Multisession SRS treatment of vestibular schwannomas results in an excellent rate of tumor control. The hearing, trigeminal nerve, and facial nerve function preservation rates reported here are promising.
Publisher
Oxford University Press,Lippincott Williams & Wilkins,Wolters Kluwer Health, Inc
Subject
/ Adult
/ Aged
/ Biological and medical sciences
/ Child
/ Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology
/ Female
/ Humans
/ Male
/ Neurofibromatosis 2 - etiology
/ Neuroma, Acoustic - mortality
/ Otorhinolaryngology. Stomatology
/ Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
/ Tumors
