Christian Iorio-Morin1, Roman Liscak2, Vilibald Vladyka2, Hideyuki Kano3, Rachel C Jacobs3, L Dade Lunsford3, Or Cohen-Inbar4, Jason Sheehan4, Reem Emad5, Khalid Abdel Karim6, Amr El-Shehaby7, Wael A Reda7, Cheng-Chia Lee8, Fu-Yuan Pai8, Amparo Wolf9, Douglas Kondziolka9, Inga Grills10, Kuei C Lee10, David Mathieu1. 1. Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada. 2. Na Homolce Hospital, Prague, Czech Republic. 3. Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 4. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia. 5. National Cancer Institute, Cairo University, Gamma Knife Center Cairo, Cairo, Egypt. 6. Clinical Oncology Department, Ain Shams University, Gamma Knife Center Cairo, Cairo, Egypt. 7. Neurosurgery Department, Ain Shams University, Gamma Knife Center Cairo, Cairo, Egypt. 8. Taipei Veterans General Hospital Neurological Institute, Taipei, Taiwan. 9. New York University Langone Medical Center, New York, New York. 10. Beaumont Gamma Knife Center, Royal Oak, Michigan.
Abstract
BACKGROUND: Stereotactic radiosurgery (SRS) is a highly effective management approach for patients with vestibular schwannomas (VS), with 10-yr control rates up 98%. When it fails, however, few data are available to guide management. OBJECTIVE: To perform a retrospective analysis of patients who underwent 2 SRS procedures on the same VS to assess the safety and efficacy of this practice. METHODS: This study was opened to centers of the International Gamma Knife Research Foundation (IGKRF). Data collected included patient characteristics, clinical symptoms at the time of SRS, radiosurgery dosimetric data, imaging response, clinical evolution, and survival. Actuarial analyses of tumor responses were performed. RESULTS: Seventy-six patients from 8 IGKRF centers were identified. Median follow-up from the second SRS was 51.7 mo. Progression after the first SRS occurred at a median of 43 mo. Repeat SRS was performed using a median dose of 12 Gy. Actuarial tumor control rates at 2, 5, and 10 yr following the second SRS were 98.6%, 92.2%, and 92.2%, respectively. Useful hearing was present in 30%, 8%, and 5% of patients at first SRS, second SRS, and last follow-up, respectively. Seventy-five percent of patients reported stable or improved symptoms following the second SRS. Worsening of facial nerve function attributable to SRS occurred in 7% of cases. There were no reports of radionecrosis, radiation-associated edema requiring corticosteroids, radiation-related neoplasia, or death attributable to the repeat SRS procedure. CONCLUSION: Patients with progressing VS after radiosurgery can be safely and effectively managed using a second SRS procedure.
BACKGROUND: Stereotactic radiosurgery (SRS) is a highly effective management approach for patients with vestibular schwannomas (VS), with 10-yr control rates up 98%. When it fails, however, few data are available to guide management. OBJECTIVE: To perform a retrospective analysis of patients who underwent 2 SRS procedures on the same VS to assess the safety and efficacy of this practice. METHODS: This study was opened to centers of the International Gamma Knife Research Foundation (IGKRF). Data collected included patient characteristics, clinical symptoms at the time of SRS, radiosurgery dosimetric data, imaging response, clinical evolution, and survival. Actuarial analyses of tumor responses were performed. RESULTS: Seventy-six patients from 8 IGKRF centers were identified. Median follow-up from the second SRS was 51.7 mo. Progression after the first SRS occurred at a median of 43 mo. Repeat SRS was performed using a median dose of 12 Gy. Actuarial tumor control rates at 2, 5, and 10 yr following the second SRS were 98.6%, 92.2%, and 92.2%, respectively. Useful hearing was present in 30%, 8%, and 5% of patients at first SRS, second SRS, and last follow-up, respectively. Seventy-five percent of patients reported stable or improved symptoms following the second SRS. Worsening of facial nerve function attributable to SRS occurred in 7% of cases. There were no reports of radionecrosis, radiation-associated edema requiring corticosteroids, radiation-related neoplasia, or death attributable to the repeat SRS procedure. CONCLUSION:Patients with progressing VS after radiosurgery can be safely and effectively managed using a second SRS procedure.
Authors: Won Jae Lee; Jung Il Lee; Jung Won Choi; Doo Sik Kong; Do Hyun Nam; Yang Sun Cho; Hyung Jin Shin; Ho Jun Seol Journal: J Korean Med Sci Date: 2021-04-26 Impact factor: 2.153
Authors: Anne Balossier; Jean Régis; Nicolas Reyns; Pierre-Hugues Roche; Roy Thomas Daniel; Mercy George; Mohamed Faouzi; Marc Levivier; Constantin Tuleasca Journal: Neurosurg Rev Date: 2021-04-13 Impact factor: 3.042