Stereotactic Radiosurgery as Primary Treatment in Fast-Growing Vestibular Schwannomas: A Meta-analysis

2021 ◽  
Author(s):  
Leanne O. Hamilton ◽  
Constantina Yiannakis ◽  
Afiq Slim ◽  
Georgios Kontorinis
Keyword(s):  
Stereotactic Radiosurgery ◽  
Meta Analysis ◽  
Primary Treatment ◽  
Vestibular Schwannomas ◽  
Fast Growing

scholarly journals Primary Treatment of Small-To-Medium (<3cm) Sporadic Vestibular Schwannomas: A Systematic Review And Meta-Analysis on Long-Term Hearing Preservation And Tumor Control Rates For Microsurgery Versus Radiosurgery.

2021 ◽  
Author(s):  
Amey Rajan Savardekar ◽  
Danielle L Terrell ◽  
Saudamini Jayant Lele ◽  
Ryan Robert Diaz ◽  
Praneeth Reddy Keesari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Meta Analysis ◽  
Treatment Options ◽  
Hearing Preservation ◽  
Primary Treatment ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Group 10

Abstract BackgroundOver the past two decades, the treatment of small-to-medium (<3cm) sporadic vestibular schwannomas (VS) has experienced a definite shift to stereotactic radiosurgery vis-a-vis microsurgery. We performed a systematic review and meta-analysis of VS patients primarily treated with stereotactic radiosurgery (SRS) or microsurgery (MS), with particular attention to hearing preservation outcomes (HPO), tumor control (TC), and facial nerve dysfunction (FND).MethodsA systematic review was conducted (Medline and Scopus database) for the period, January 2010 to June 2020 with appropriate MeSH. English language articles for small-to-medium sporadic VS (<3cm) utilizing SRS or MS as treatment modality, with minimum follow-up of 3 years, were included. Studies had to report an acceptable standardized hearing metric. HPO, TC, and FND rates were analyzed. ResultsThirty-two studies met inclusion criteria: 10 for microsurgery; 23 for radiosurgery (one comparative study included in both). HPO, at ~65 months follow-up, were comparable between MS group (10 studies; 809 patients) and SRS group (23 studies; 1234 patients) (56% versus 59%, p=0.1527). TC, at ~70 months follow-up, was significantly better in MS group (9 studies; 1635 patients) versus SRS group (19 studies; 2260 patients) (98% versus 92%, p < 0.0001). FND, at ~ 12 months follow-up, was significantly higher in MS group (8 studies; 1101 patients) versus SRS group (17 studies; 2285 patients) (10% versus 2%, p < 0.0001).ConclusionMS and SRS are comparable primary treatment options for small (<3cm) sporadic VS with respect to HPO at 5-year follow-up in patients with serviceable hearing at presentation. Approximately 50% patients for both modalities will likely lose serviceable hearing by that time-point. High TC rates (>90%) were seen with both modalities, with MS (98%) significantly better than SRS (92%). The post-treatment FND was significantly less with SRS group (2%) versus MS group (10%).

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.

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.

scholarly journals Outcomes of Stereotactic Radiosurgery for Large Vestibular Schwannomas: a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Umberto Tosi ◽  
Miguel E Tusa Lavieri ◽  
Anjile An ◽  
Omri Maayan ◽  
Sergio W Guadix ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Cranial Nerve ◽  
Meta Analysis ◽  
Management Strategies ◽  
Treatment Protocol ◽  
Vestibular Schwannomas ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Pre Treatment

Abstract Background Large vestibular schwannomas (VS) pose a treatment challenge for both microsurgery (MS) and stereotactic radiosurgery (SRS). Technical developments have allowed for safer irradiation of large tumors. It remains unclear if SRS can achieve appropriate tumor control and acceptable cranial nerve toxicities. In this study, we assess outcomes of irradiation for large VS. Methods PubMed MEDLINE, EMBASE, Web of Science, and Cochrane were searched for all the studies assessing SRS outcome in large VS. Primary endpoints included clinical and radiographic tumor control, need for salvage surgery, serviceable hearing, cranial nerve V and VII impairment, presence of hydrocephalus requiring shunting, and presence of vertigo / dizziness. Results 22 studies were identified that met selection criteria for analysis from an initial pool of 1272 reports. They were evaluated according to treatment protocol: (i) single dose SRS (13 studies, 483 patients), (ii) combination of MS and SRS (7 studies, 182 patients), and (iii) fractionated SRS (3 studies, 82 patients). Tumor control was achieved in 89%, 94%, and 91% of patients, respectively. Odds ratio of post- over pre-treatment serviceable hearing were 0.42 (p &lt; 0.01), 0.47 (p = 0.05), and 0.60 (p = 0.22); for facial nerve impairment, these OR were 1.08 (p = 0.69), 3.45 (p = 0.28), and 0.87 (p = 0.71) respectively. Conclusions The management of large VS remains challenging. All treatment modalities resulted in high tumor control rates and worsening of pre-treatment hearing. None, however, caused significant facial nerve impairment, suggesting that management strategies incorporating focal irradiation can be successful.

scholarly journals Repeat stereotactic radiosurgery for progressive vestibular schwannomas after previous radiosurgery: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Anne Balossier ◽  
Jean Régis ◽  
Nicolas Reyns ◽  
Pierre-Hugues Roche ◽  
Roy Thomas Daniel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hearing Loss ◽  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Cranial Nerve ◽  
Meta Analysis ◽  
Cranial Nerves ◽  
Vestibular Schwannomas ◽  
Benign Tumors ◽  
Tumor Control

AbstractVestibular schwannomas (VS) are slow-growing intracranial extraaxial benign tumors, developing from the vestibular part of the eight cranial nerves. Stereotactic radiosurgery (SRS) has now a long-term scientific track record as first intention treatment for small- to medium-sized VS. Though its success rate is very high, SRS for VS might fail to control tumor growth in some cases. However, the literature on repeat SRS after previously failed SRS remains scarce and reported in a low number of series with a limited number of cases. Here, we aimed at performing a systematic review and meta-analysis of the literature on repeat SRS for VS. Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2020 and referenced in PubMed. Tumor control and cranial nerve outcomes were evaluated with separate meta-analyses. Eight studies comprising 194 patients were included. The overall rate of patients treated in repeat SRS series as per overall series with first SRS was 2.2% (range 1.2–3.2%, p < 0.001). The mean time between first and second SRS was 50.7 months (median 51, range 44–64). The median marginal dose prescribed at first SRS was 12 Gy (range 8–24) and at second SRS was 12 Gy (range 9.8–19). After repeat SRS, tumor stability was reported in 61/194 patients, i.e., a rate of 29.6% (range 20.2–39%, I2 = 49.1%, p < 0.001). Tumor decrease was reported in 83/194 patients, i.e., a rate of 54.4% (range 33.7–75.1%, I2 = 89.1%, p < 0.001). Tumor progression was reported in 50/188 patients, i.e., a rate of 16.1% (range 2.5–29.7%, I2 = 87.1%, p = 0.02), rarely managed surgically. New trigeminal numbness was reported in 27/170 patients, i.e., a rate of 9.9% (range 1.4–18.3%, p < 0.02). New facial nerve palsy of worsened of previous was reported in 8/183 patients, i.e., a rate of 4.3% (range 1.4–7.2%, p = 0.004). Hearing loss was reported in 12/22 patients, i.e., a rate of 54.3% (range 24.8–83.8%, I2 = 70.7%, p < 0.001). Repeat SRS after previously failed SRS for VS is associated with high tumor control rates. Cranial nerve outcomes remain favorable, particularly for facial nerve. The rate of hearing loss appears similar to the one related to first SRS.

Medium Term Outcome of LINAC-Based Stereotactic Radiosurgery for Vestibular Schwannomas with Marginal Dose of 12.5 Gy

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
J. Ellenbogen ◽  
A. Kinshuck ◽  
M. Jenkinson ◽  
T. Lesser ◽  
D. Husband ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vestibular Schwannomas ◽  
Medium Term ◽  
Term Outcome

scholarly journals Biologically effective dose correlates with linear tumor volume changes after upfront single-fraction stereotactic radiosurgery for vestibular schwannomas

2021 ◽  
Author(s):  
Constantin Tuleasca ◽  
Mohamed Faouzi ◽  
Philippe Maeder ◽  
Raphael Maire ◽  
Jonathan Knisely ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Effective Dose ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Vestibular Schwannomas ◽  
Benign Tumors ◽  
Biologically Effective Dose ◽  
Volume Changes ◽  
Single Fraction

AbstractVestibular schwannomas (VSs) are benign, slow-growing tumors. Management options include observation, surgery, and radiation. In this retrospective trial, we aimed at evaluating whether biologically effective dose (BED) plays a role in tumor volume changes after single-fraction first intention stereotactic radiosurgery (SRS) for VS. We compiled a single-institution experience (n = 159, Lausanne University Hospital, Switzerland). The indication for SRS was decided after multidisciplinary discussion. Only cases with minimum 3 years follow-up were included. The Koos grading, a reliable method for tumor classification was used. Radiosurgery was performed using Gamma Knife (GK) and a uniform marginal prescription dose of 12 Gy. Mean BED was 66.3 Gy (standard deviation 3.8, range 54.1–73.9). The mean follow-up period was 5.1 years (standard deviation 1.7, range 3–9.2). The primary outcome was changes in 3D volumes after SRS as function of BED and of integral dose received by the VS. Random-effect linear regression model showed that tumor volume significantly and linearly decreased over time with higher BED (p < 0.0001). Changes in tumor volume were also significantly associated with age, sex, number of isocenters, gradient index, and Koos grade. However, the effect of BED on tumor volume change was moderated by time after SRS and Koos grade. Lower integral doses received by the VSs were inversely correlated with BED in relationship with tumor volume changes (p < 0.0001). Six (3.4%) patients needed further intervention. For patients having uniformly received the same marginal dose prescription, higher BED linearly and significantly correlated with tumor volume changes after SRS for VSs. BED could represent a potential new treatment paradigm for patients with benign tumors, such as VSs, for attaining a desired radiobiological effect. This could further increase the efficacy and decrease the toxicity of SRS not only in benign tumors but also in other SRS indications.

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