May N Tsao1, Arjun Sahgal1, Wei Xu2, Antonio De Salles3, Motohiro Hayashi4, Marc Levivier5, Lijun Ma6, Roberto Martinez7, Jean Régis8, Sam Ryu9, Ben J Slotman10, Ian Paddick11. 1. Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Toronto, ON, Canada, M4N 3M5. 2. Department of Biostatistics, University of Toronto, ON, Canada, M5G 2M9. 3. Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90005, USA and HCor Neuroscience, Sao Paulo, SP, Brazil, 04004-030. 4. Department of Neurosurgery, Tokyo Women's Medical University, Toyko, Japan, 162-8666. 5. Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland. 6. Division Physics, Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA. 7. Department Neurosurgery, Ruber Internacional Hospital, E-28034 Madrid, Spain. 8. Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, F-13385 Marseille, France. 9. Department of Radiation Oncology and Neurosurgery, Stony Brook University, Stony Brook, NY 11794, USA. 10. Department of Radiation Oncology, VU University Medical Center, NL-1007 Amsterdam, Netherlands. 11. National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK.
Abstract
OBJECTIVES: The aim of this systematic review was to develop International Stereotactic Radiosurgery Society (ISRS) consensus guideline statements for vestibular schwannoma. METHODS: A systematic review of the literature was performed up to April 2015. RESULTS: A total of 55 full-text articles were included in the analysis. All studies were retrospective, except for 2 prospective quality of life studies. Five-year tumour control rates with Gamma Knife radiosurgery (RS), single fraction linac RS, or fractionated (either hypofractionated or conventional fractionation) stereotactic radiation therapy (FSRT) were similar at 81-100%. The single fraction RS series (linac or Gamma Knife) with tumour marginal doses between 12 and 14 Gy revealed 5-year tumour control rates of 90-99%, hearing preservation rates of 41-79%, facial nerve preservation rates of 95-100% and trigeminal preservation rates of 79-99%.There were 6 non-randomized studies comparing single fraction RS versus FSRT. There was no statistically significant difference in tumour control; HR=1.66 (95% CI 0.81, 3.42), p =0.17, facial nerve function; HR = 0.67 (95% CI 0.30, 1.49), p =0.33, trigeminal nerve function; HR = 0.80 (95% CI 0.41, 1.56), p =0.51, and hearing preservation; HR = 1.10 (95% CI 0.72, 1.68), p =0.65 comparing single fraction RS with FSRT.Nine quality of life reports yielded conflicting results as to which modality (surgery, observation, or radiation) was associated with better quality of life outcomes. CONCLUSIONS: There are no randomized trials to help guide management of patients with vestibular schwannoma. Within the limitations of the retrospective series, a number of consensus statements were made.
OBJECTIVES: The aim of this systematic review was to develop International Stereotactic Radiosurgery Society (ISRS) consensus guideline statements for vestibular schwannoma. METHODS: A systematic review of the literature was performed up to April 2015. RESULTS: A total of 55 full-text articles were included in the analysis. All studies were retrospective, except for 2 prospective quality of life studies. Five-year tumour control rates with Gamma Knife radiosurgery (RS), single fraction linac RS, or fractionated (either hypofractionated or conventional fractionation) stereotactic radiation therapy (FSRT) were similar at 81-100%. The single fraction RS series (linac or Gamma Knife) with tumour marginal doses between 12 and 14 Gy revealed 5-year tumour control rates of 90-99%, hearing preservation rates of 41-79%, facial nerve preservation rates of 95-100% and trigeminal preservation rates of 79-99%.There were 6 non-randomized studies comparing single fraction RS versus FSRT. There was no statistically significant difference in tumour control; HR=1.66 (95% CI 0.81, 3.42), p =0.17, facial nerve function; HR = 0.67 (95% CI 0.30, 1.49), p =0.33, trigeminal nerve function; HR = 0.80 (95% CI 0.41, 1.56), p =0.51, and hearing preservation; HR = 1.10 (95% CI 0.72, 1.68), p =0.65 comparing single fraction RS with FSRT.Nine quality of life reports yielded conflicting results as to which modality (surgery, observation, or radiation) was associated with better quality of life outcomes. CONCLUSIONS: There are no randomized trials to help guide management of patients with vestibular schwannoma. Within the limitations of the retrospective series, a number of consensus statements were made.
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