scholarly journals Tumor control and trigeminal dysfunction improvement after stereotactic radiosurgery for trigeminal schwannomas: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Iulia Peciu-Florianu ◽  
Jean Régis ◽  
Marc Levivier ◽  
Michaela Dedeciusova ◽  
Nicolas Reyns ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Symptomatic Improvement ◽  
Tumor Control ◽  
Linear Accelerators ◽  
Oculomotor Nerves ◽  
Clinical Worsening

AbstractTrigeminal nerve schwannomas (TS) are uncommon intracranial tumors, frequently presenting with debilitating trigeminal and/or oculomotor nerve dysfunction. While surgical resection has been described, its morbidity and mortality rates are non-negligible. Stereotactic radiosurgery (SRS) has emerged with variable results as a valuable alternative. Here, we aimed at reviewing the medical literature on TS treated with SRS so as to investigate rates of tumor control and symptomatic improvement. We reviewed manuscripts published between January 1990 and December 2019 on PubMed. Tumor control and symptomatic improvement rates were evaluated with separate meta-analyses. This meta-analysis included 18 studies comprising a total of 564 patients. Among them, only one reported the outcomes of linear accelerators (Linac), while the others of GK. Tumor control rates after SRS were 92.3% (range 90.1–94.5; p < 0.001), and tumor decrease rates were 62.7% (range 54.3–71, p < 0.001). Tumor progression rates were 9.4% (range 6.8–11.9, p < 0.001). Clinical improvement rates of trigeminal neuralgia were 63.5% (52.9–74.1, p < 0.001) and of oculomotor nerves were 48.2% (range 36–60.5, p < 0.001). Clinical worsening rate was 10.7% (range 7.6–13.8, p < 0.001). Stereotactic radiosurgery for TS is associated with high tumor control rates and favorable clinical outcomes, especially for trigeminal neuralgia and oculomotor nerves. However, patients should be correctly advised about the risk of tumor progression and potential clinical worsening. Future clinical studies should focus on standard reporting of clinical outcomes.

Comparison of Surgical Outcomes and Recurrence Rates of Cystic and Solid Vestibular Schwannomas

2019 ◽  
Author(s):  
Rami O. Almefty ◽  
David S. Xu ◽  
Michael A. Mooney ◽  
Andrew Montoure ◽  
Komal Naeem ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Facial Nerve ◽  
Tumor Progression ◽  
Clinical Outcomes ◽  
Univariate Analysis ◽  
Growth Patterns ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Cystic Tumors

Abstract Objective Cystic vestibular schwannomas (CVSs) are anecdotally believed to have worse clinical and tumor-control outcomes than solid vestibular schwannomas (SVSs); however, no data have been reported to support this belief. In this study, we characterize the clinical outcomes of patients with CVSs versus those with SVSs. Design This is a retrospective review of prospectively collected data. Setting This study is set at single high-volume neurosurgical institute. Participants We queried a database for details on all patients diagnosed with vestibular schwannomas between January 2009 and January 2014. Main Outcome Measures Records were retrospectively reviewed and analyzed using univariate and multivariate analyses to study the differences in clinical outcomes and tumor progression or recurrence. Results Of a total of 112 tumors, 24% (n = 27) were CVSs and 76% (n = 85) were SVSs. Univariate analysis identified the extent of resection, Koos grade, and tumor diameter as significant predictors of recurrence (p ≤ 0.005). However, tumor diameter was the only significant predictor of recurrence in the multivariate analysis (p = 0.007). Cystic change was not a predictor of recurrence in the univariate or multivariate analysis (p ≥ 0.40). Postoperative facial nerve and hearing outcomes were similar for both CVSs and SVSs (p ≥ 0.47). Conclusion Postoperative facial nerve outcome, hearing, tumor progression, and recurrence are similar for patients with CVSs and SVSs. As CVS growth patterns and responses to radiation are unpredictable, we favor microsurgical resection over radiosurgery as the initial treatment. Our data do not support the commonly held belief that cystic tumors behave more aggressively than solid tumors or are associated with increased postoperative facial nerve deficits.

scholarly journals Tumor Control Rates in Patients Undergoing Stereotactic Radiosurgery for Cystic Vestibular Schwannomas: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Kevin Ding ◽  
Edwin Ng ◽  
Prasanth Romiyo ◽  
Dillon Dejam ◽  
Courtney Duong ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Meta Analysis ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Limiting Factor ◽  
Tumor Control Rate ◽  
Pertinent Data ◽  
Funnel Plots ◽  
Initial Impressions

Abstract INTRODUCTION Cystic vestibular schwannomas (VS) represent a subtype that grows more rapidly due to expansion of cystic contents and are important candidates for stereotactic radiosurgery (SRS) intervention due to their tendency to adhere to the neurovasculature. However, the paucity of comprehensive outcomes data is currently a limiting factor to understanding the potential of using SRS to treat cystic VS. METHODS This study was conducted in accordance with the PRISMA guidelines. A search was conducted in October 2018 through the PubMed, Scopus, Embase, Web of Science, and Cochrane databases. Data on tumor control rates were extracted and analyzed using meta-analysis and tests for heterogeneity between articles, with the t2, Cochran's Q, and I2 statistics reported. Publication bias was assessed using funnel plots and Egger's testing. RESULTS A total of 246 patients underwent SRS for cystic VS, with reported mean or median follow-up of 49.7 to 150 mo. Following SRS treatment for cystic VS across all studies, 92% of patients had tumor control at follow up, (95%-CI: 88%-95%). In studies that specifically reported tumor control rate at 5 yr, control rate was also 92% (95%-CI: 87%-95%). Tumor control rate specifically for patients who underwent GammaKnife was 93% (95%-CI: 88%-95%). CONCLUSION Results of our meta-analysis suggest that SRS is a viable treatment option for cystic VS, exhibiting effective tumor control rates. Despite the paucity of pertinent data, our conclusions provide evidence in contrast to the initial impressions of SRS treatment for cystic VS within the neurosurgical community.

Stereotactic Radiosurgery Treatment of Trigeminal Neuralgia: Clinical Outcomes and Prognostic Factors

2016 ◽  
Vol 90 ◽  
pp. 604-612.e11 ◽  
Author(s):  
Zachary J. Taich ◽  
Steven J. Goetsch ◽  
Elsa Monaco ◽  
Bob S. Carter ◽  
Kenneth Ott ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Clinical Outcomes

scholarly journals Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients

2019 ◽  
Vol 130 (6) ◽  
pp. 1799-1808 ◽  
Author(s):  
Kyung-Jae Park ◽  
Hideyuki Kano ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
Daniel A. Tonetti ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Cavernous Sinus Meningioma ◽  
Long Term Study

OBJECTIVEThe authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).METHODSThe authors retrospectively assessed treatment outcomes 5–18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22–83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1–37.3 cm3), and the median margin dose was 13.0 Gy (range 10–20 Gy).RESULTSTumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8–120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438–12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041–0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3–85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026–12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS.CONCLUSIONSThis long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.

Meta-analysis of tumor control rates in patients undergoing stereotactic radiosurgery for cystic vestibular schwannomas

2020 ◽  
Vol 188 ◽  
pp. 105571 ◽  
Author(s):  
Kevin Ding ◽  
Edwin Ng ◽  
Prasanth Romiyo ◽  
Dillon Dejam ◽  
Methma Udawatta ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Meta Analysis ◽  
Vestibular Schwannomas ◽  
Tumor Control

scholarly journals RADT-16. HYPOFRACTIONATED RADIOTHERAPY AND STEREOTACTIC RADIOSURGERY FOR VESTIBULAR SCHWANNOMAS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii184-ii185
Author(s):  
Umberto Tosi ◽  
Sergio Guadix ◽  
Anjile An ◽  
Drew Wright ◽  
Andrew Brandmaier ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Cranial Nerve ◽  
Meta Analysis ◽  
Post Treatment ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Significant Heterogeneity ◽  
Ovid Medline ◽  
Cochrane Reviews

Abstract BACKGROUND Vestibular schwannomas (VS) are tumors of the cerebellopontine angle with significant morbidity, causing hearing loss, tinnitus, and trigeminal and facial nerve compromise. Surgical resection is complex and often results in comorbidities, with radiation therapy being used to achieve tumor control. Both single dose stereotactic radiosurgery (SRS) and, in recent years, hypofractionated stereotactic radiotherapy (hSRT), where a total 18-25 Gy dose is given in approximately 3-5 fractions, have been utilized. It remains unclear, however, how each of these approaches fares compared to the other. METHODS Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews were searched for studies either comparing hSRT with SRS or focusing on hSRT alone for the treatment of VS. Primary endpoints included tumor control, serviceable hearing, presence of tinnitus, and facial and trigeminal nerve symptoms. A random effects analysis was employed to compare pre- and post-treatment effects (hSRT alone) or SRS and hSRT outcomes (two-arm studies). RESULTS This analysis included 21 studies focusing on hSRT alone and 13 studies comparing SRS and hSRT. Significant heterogeneity was observed. Overall, when hSRT was analyzed alone, crude tumor control was achieved in 93% of 1571 patients at average follow-up of 49.9 months. There was no difference intra-group between pre- and post-treatment odds ratios (OR) of tinnitus, facial, or trigeminal impairment. However, serviceable hearing was diminished following hSRT (OR = 0.60, 95% CI: 0.44, 0.83, p = 0.002). Comparison with SRS showed no difference with respect to tumor control (p = 0.84), serviceable hearing (p = 0.65), trigeminal impairment (p = 0.96), or facial nerve impairment (p = 0.32). CONCLUSIONS hSRT achieved excellent tumor control and, with the exception of serviceable hearing, did not result in worse cranial nerve symptomatology. Analyzing two-arm studies showed that hSRT is a treatment modality comparable to SRS with respect to tumor control and cranial nerve comorbidities.

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