Chloe Dumot1,2, Stylianos Pikis1, Georgios Mantziaris1, Zhiyuan Xu1, Rithika Kormath Anand1, Ahmed M Nabeel3,4, Darrah Sheehan1, Kimball Sheehan1, Wael A Reda3,5, Sameh R Tawadros3,5, Khaled Abdel Karim3,6, Amr M N El-Shehaby3,5, Reem M Emad Eldin3,7, Selcuk Peker8, Yavuz Samanci8, Tehila Kaisman-Elbaz9, Herwin Speckter10, Wenceslao Hernández10, Julio Isidor10, Manjul Tripathi11, Renu Madan12, Brad E Zacharia13, Lekhaj C Daggubati13, Nuria Martínez Moreno14, Roberto Martínez Álvarez14, Anne-Marie Langlois15, David Mathieu15, Christopher P Deibert16, Vivek R Sudhakar17, Christopher P Cifarelli17,18, Denisse Arteaga Icaza17, Daniel T Cifarelli17, Zhishuo Wei19, Ajay Niranjan19, Gene H Barnett9, L Dade Lunsford19, Greg N Bowden20, Jason P Sheehan21. 1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA. 2. Department of Neurological Surgery, Hospices civils de Lyon, Lyon, France. 3. Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt. 4. Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt. 5. Department of Neurosurgery, Faculty of Medecine, Ain Shams University, Cairo, Egypt. 6. Department of Clinical Oncology, Faculty of Medecine, Ain Shams University, Cairo, Egypt. 7. Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt. 8. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey. 9. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. 10. Department of Radiology, Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic. 11. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 12. Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 13. Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA. 14. Department of Radiosurgery, Rúber International Hospital, Madrid, Spain. 15. Division of Neurosurgery, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada. 16. Department of Neurological Surgery, Emory University, Atlanta, Georgia. 17. Department of Neurosurgery, West Virginia University, Morgantown, WV, USA. 18. Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA. 19. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA. 20. Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada. 21. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA. jsheehan@virginia.edu.
Abstract
PURPOSE: Surgery is the treatment of choice for large vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has been suggested as an alternative to resection in selected patients. However, the safety and efficacy of SRS in Koos grade IV patients ≤ 45 years old has not been evaluated. The aim of this study is to describe the clinical and radiological outcomes of Koos grade IV in young patient managed with a single-session SRS. METHODS: This retrospective, multicenter analysis included SRS-treated patients, ≤ 45 years old presenting with non-life threatening or incapacitating symptoms due to a Koos Grade IV VS and with follow-up ≥ 12 months. Tumor control and neurological outcomes were evaluated. RESULTS: 176 patients [median age of 36.0 (IQR 9) and median tumor volume of 9.3 cm3 (IQR 4.7)] were included. The median prescription dose was 12 Gy (IQR 0.5). Median follow-up period was 37.5 (IQR 53.5) months. The 5- and 10-year progression-free survival was 90.9% and 86.7%. Early tumor enlargement occurred in 10.9% of cases and was associated with tumor progression at the last follow-up. The probability of serviceable hearing preservation at 5- and 10-years was 56.8% and 45.2%, respectively. The probability of improvement or preservation of facial nerve function was 95.7% at 5 and 10-years. Adverse radiation effects were noted in 19.9%. New-onset hydrocephalus occurred in 4.0%. CONCLUSION: Single-session SRS is a safe and effective alternative to surgical resection in selected patients ≤ 45 years old particularly those with medical co-morbidities and those who decline resection. Longer term follow up is warranted.
PURPOSE: Surgery is the treatment of choice for large vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has been suggested as an alternative to resection in selected patients. However, the safety and efficacy of SRS in Koos grade IV patients ≤ 45 years old has not been evaluated. The aim of this study is to describe the clinical and radiological outcomes of Koos grade IV in young patient managed with a single-session SRS. METHODS: This retrospective, multicenter analysis included SRS-treated patients, ≤ 45 years old presenting with non-life threatening or incapacitating symptoms due to a Koos Grade IV VS and with follow-up ≥ 12 months. Tumor control and neurological outcomes were evaluated. RESULTS: 176 patients [median age of 36.0 (IQR 9) and median tumor volume of 9.3 cm3 (IQR 4.7)] were included. The median prescription dose was 12 Gy (IQR 0.5). Median follow-up period was 37.5 (IQR 53.5) months. The 5- and 10-year progression-free survival was 90.9% and 86.7%. Early tumor enlargement occurred in 10.9% of cases and was associated with tumor progression at the last follow-up. The probability of serviceable hearing preservation at 5- and 10-years was 56.8% and 45.2%, respectively. The probability of improvement or preservation of facial nerve function was 95.7% at 5 and 10-years. Adverse radiation effects were noted in 19.9%. New-onset hydrocephalus occurred in 4.0%. CONCLUSION: Single-session SRS is a safe and effective alternative to surgical resection in selected patients ≤ 45 years old particularly those with medical co-morbidities and those who decline resection. Longer term follow up is warranted.
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