Andrea Lo1, Gareth Ayre2, Roy Ma2, Fred Hsu3, Ryojo Akagami4, Michael McKenzie2, Boris Valev5, Ermias Gete6, Isabelle Vallieres7, Alan Nichol2. 1. Department of Radiation Therapy, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: alo3@bccancer.bc.ca. 2. Department of Radiation Therapy, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 3. Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Therapy, BC Cancer Agency Abbotsford Centre, Abbotsford, British Columbia, Canada. 4. Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Neurosurgery, Vancouver General Hospital, Vancouver, British Columbia, Canada. 5. Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Therapy, BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada. 6. Department of Radiation Therapy, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada. 7. Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Therapy, BC Cancer Agency Vancouver Island Centre, Victoria, British Columbia, Canada.
Abstract
PURPOSE: To examine long-term local control of vestibular schwannoma and side effects in patients treated with stereotactic radiosurgery (SRS) and fractionated stereotactic radiation therapy (SRT) in British Columbia. METHODS AND MATERIALS: From August 1998 to May 2009, 207 patients were treated with radiation therapy (RT) at British Columbia Cancer Agency. 136 (66%) received SRS, and 71 (34%) received SRT. Dose prescriptions were 50 Gy/25 fractions for SRT and 12 Gy/1 fraction for SRS. Our multidisciplinary provincial neuro-stereotactic conference recommended SRT for tumors >3 cm and for patients with serviceable hearing (Gardner-Robertson classes I and II). RESULTS: Median follow-up was 7.7 years to the last MRI and 6.4 years to the last clinical assessment. Local control for SRS versus SRT was 94% versus 87% at 5 years and 90% versus 85% at 10 years (P=.2). Five- and 10-year actuarial rates of RT-induced trigeminal nerve dysfunction were 25% and 25% after SRS, compared with 7% and 12% after SRT (P=.01). Five- and 10-year actuarial rates of RT-induced facial nerve dysfunction were 15% and 15% after SRS, versus 13% and 15% after SRT (P=.93). In the 49 patients with serviceable hearing at baseline who were treated with SRT, hearing preservation was 55% at 3 years, 37% at 5 years, and 29% at 7 years. In multivariable analysis, better pretreatment ipsilateral pure tone average was significantly associated with hearing preservation (hazard ratio 1.03; 95% confidence interval 1.00-1.07; P=.04). CONCLUSIONS: Both SRS and SRT provided excellent long-term local control of vestibular schwannoma. Stereotactic radiosurgery was associated with higher rates of trigeminal nerve dysfunction. Even with a fractionated course, hearing preservation declined steadily with long-term audiometric follow-up.
PURPOSE: To examine long-term local control of vestibular schwannoma and side effects in patients treated with stereotactic radiosurgery (SRS) and fractionated stereotactic radiation therapy (SRT) in British Columbia. METHODS AND MATERIALS: From August 1998 to May 2009, 207 patients were treated with radiation therapy (RT) at British Columbia Cancer Agency. 136 (66%) received SRS, and 71 (34%) received SRT. Dose prescriptions were 50 Gy/25 fractions for SRT and 12 Gy/1 fraction for SRS. Our multidisciplinary provincial neuro-stereotactic conference recommended SRT for tumors >3 cm and for patients with serviceable hearing (Gardner-Robertson classes I and II). RESULTS: Median follow-up was 7.7 years to the last MRI and 6.4 years to the last clinical assessment. Local control for SRS versus SRT was 94% versus 87% at 5 years and 90% versus 85% at 10 years (P=.2). Five- and 10-year actuarial rates of RT-induced trigeminal nerve dysfunction were 25% and 25% after SRS, compared with 7% and 12% after SRT (P=.01). Five- and 10-year actuarial rates of RT-induced facial nerve dysfunction were 15% and 15% after SRS, versus 13% and 15% after SRT (P=.93). In the 49 patients with serviceable hearing at baseline who were treated with SRT, hearing preservation was 55% at 3 years, 37% at 5 years, and 29% at 7 years. In multivariable analysis, better pretreatment ipsilateral pure tone average was significantly associated with hearing preservation (hazard ratio 1.03; 95% confidence interval 1.00-1.07; P=.04). CONCLUSIONS: Both SRS and SRT provided excellent long-term local control of vestibular schwannoma. Stereotactic radiosurgery was associated with higher rates of trigeminal nerve dysfunction. Even with a fractionated course, hearing preservation declined steadily with long-term audiometric follow-up.
Authors: Sergio W Guadix; Alice J Tao; Anjile An; Michelle Demetres; Umberto Tosi; Swathi Chidambaram; Jonathan P S Knisely; Rohan Ramakrishna; Susan C Pannullo Journal: Neurooncol Pract Date: 2021-08-13
Authors: Felix Arlt; Johannes Kasper; Dirk Winkler; Katja Jähne; Michael Karl Fehrenbach; Jürgen Meixensberger; Caroline Sander Journal: Front Neurol Date: 2022-05-24 Impact factor: 4.086