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Kamogawa M, Tanino S, Miyahara K, Shuto T, Matsunaga S, Okada T, Noda N, Sekiguchi N, Suzuki K, Tanaka Y, Uriu Y. Surgical and radiosurgical outcomes for Koos grade 3 vestibular schwannomas. Neurosurg Rev 2024; 47:398. [PMID: 39095539 DOI: 10.1007/s10143-024-02637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/07/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
This study aimed to reveal the preferred initial treatment for Koos grade 3 vestibular schwannomas (VS). We performed a two-institutional retrospective study on 21 patients with Koos grade 3 VS undergoing resection at Yokohama Medical Center and 37 patients undergoing radiosurgery at Yokohama Rosai Hospital from 2010 to 2021. Tumor control, complications, and functional preservation were compared. The median pre-treatment volume and follow-up duration were 2845 mm3 and 57.0 months, respectively, in the resection group and 2127 mm3 and 81.7 months, respectively, in the radiosurgery group. In the resection group, 16 (76.2%) underwent gross total resection, and three patients (14.3%) experienced regrowth; however, no one required additional treatment. In the radiosurgery group, the tumor control rate was 86.5%, and three cases (8.1%) required surgical resection because of symptomatic brainstem compression. Kaplan-Meier analyses revealed that tumors with delayed continuous enlargement and large thin-walled cysts were significantly associated with poor prognostic factors (p = 0.0027, p < 0.001). The pre-radiosurgery growth rate was also associated with the volume increase (p = 0.013). Two cases (9.5%) required additional operation due to complications such as post-operative hematoma and cerebrospinal fluid leaks in the resection group, whereas temporary cranial neuropathies were observed in the radiosurgery group. Two patients (9.5%) had poor facial nerve function (House-Brackmann grading grade 3) in the resection group, while no one developed facial paresis in the radiosurgery group. Trigeminal neuropathy improved only in the resection group.Radiosurgery can be considered for the treatment of Koos grade 3 VS for functional preservation. However, resection may also be considered for patients with severe trigeminal neuropathy or a high risk of volume increments, such as large thin-walled cysts and rapid pre-treatment growth.
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Affiliation(s)
- Misaki Kamogawa
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan.
| | - Shin Tanino
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Kosuke Miyahara
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Takashi Shuto
- Department of Neurosurgery, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Shigeo Matsunaga
- Department of Neurosurgery, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Tomu Okada
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Naoyuki Noda
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Noriaki Sekiguchi
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Koji Suzuki
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Yusuke Tanaka
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Yasuhiro Uriu
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
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Pseudoprogression of Vestibular Schwannoma after Stereotactic Radiosurgery with Cyberknife ®: Proposal for New Response Criteria. Cancers (Basel) 2023; 15:cancers15051496. [PMID: 36900290 PMCID: PMC10000564 DOI: 10.3390/cancers15051496] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
(1) Background: Transient increase in volume of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS) is common and complicates differentiation between treatment-related changes (pseudoprogression, PP) and tumor recurrence (progressive disease, PD). (2) Methods: Patients with unilateral VS (n = 63) underwent single fraction robotic-guided SRS. Volume changes were classified according to existing RANO criteria. A new response type, PP, with a >20% transient increase in volume was defined and divided into early (within the first 12 months) and late (>12 months) occurrence. (3) Results: The median age was 56 (range: 20-82) years, the median initial tumor volume was 1.5 (range: 0.1-8.6) cm3. The median radiological and clinical follow-up time was 66 (range: 24-103) months. Partial response was observed in 36% (n = 23), stable disease in 35% (n = 22) and PP in 29% (n = 18) of patients. The latter occurred early (16%, n = 10) or late (13%, n = 8). Using these criteria, no case of PD was observed. (4) Conclusion: Any volume increase after SRS for vs. assumed to be PD turned out to be early or late PP. Therefore, we propose modifying RANO criteria for SRS of VS, which may affect the management of vs. during follow-up in favor of further observation.
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Wu X, Wang X, Song G, Li M, Hou C, Chen G, Guo H, Xiao X, Tang J, Lin Q, Bao Y, Liang J. The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial. Trials 2022; 23:492. [PMID: 35701794 PMCID: PMC9194341 DOI: 10.1186/s13063-022-06437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is an ongoing discussion about the advantages and disadvantages of different surgical positions (semi-sitting and lateral position) for vestibular schwannoma surgery. Each position has its advantages, disadvantages, challenges, and risk profiles. The objectives of this study are to compare the effects of different surgical positions (semi-sitting and lateral position) on the outcomes of large vestibular schwannoma, primarily including effectiveness and safety. Methods In this single-centre, open, randomized controlled trial, we will recruit a total of 116 participants according to the inclusion and exclusion criteria who will be randomized to an experimental group or control group. Patients will undergo operations in semi-sitting and lateral positions. The primary endpoint will be the percentage of gross total resection. The secondary endpoints will include the facial nerve function, hearing preservation, surgical position placement time, time of operation (skin-to-skin surgical time), hospital stay, total hospitalization fee, and complications. The follow-up period will be at least 12 months, during which time patients will be evaluated both clinically and radiologically. Discussion This issue is still debated after 30 years since the first large comparative study was published in 1989, so the study will be useful. Therefore, more high-quality studies are required to compare clinical outcomes, complications, and other factors associated with these two positions. Trial registration Chinese Clinical Trial Registry ChiCTR1900027550. Registered on 17 November 2019
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Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Chengbei Hou
- Centre for Evidence-Based Medicine, Xuanwu Hospital, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Qingtang Lin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. .,International Neuroscience Institute (China-INI), Beijing, China.
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Fouard O, Daisne JF, Wanet M, Regnier M, Gustin T. Long-term volumetric analysis of vestibular schwannomas following stereotactic radiotherapy: Practical implications for follow-up. Clin Transl Radiat Oncol 2022; 33:1-6. [PMID: 34977365 PMCID: PMC8688865 DOI: 10.1016/j.ctro.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022] Open
Abstract
Pseudoprogression may be a late phenomenon after radiosurgery. Loss of central contrast enhancement is not predictive of tumor control. No decision of salvage therapy should be made until the 6th year post-treatment.
Background and purpose Transient tumor swelling is a well-known phenomenon following radiotherapy for vestibular schwannomas (VS). We analyzed the long-term volumetric changes of VS after LINAC radiosurgery, in order to determine a time interval during which a true tumor progression can be distinguished from a pseudoprogression. Methods Among 63 patients with VS treated by one fraction or fractionated radiotherapy, we selected 52 of them who had a minimal follow-up of 5 years. Maximal axial diameter and three-dimensional tumor volume were measured on each MRI scan. Volume changes were interpreted using different error margins ranging from 10 to 20%. Patients were categorized according to the tumor evolution pattern over time. Results Median follow-up was 83 months. One tumor (1.9%) remained stable and 26.9% had continuous shrinkage. Applying an error margin of 13%, a transient tumor enlargement was observed in 63.5% of patients, with a first peak at 6–12 months and a late peak at 3–4 years. A true progression was suspected in 4 (7.7%) patients, tumor regrowth starting after the 3rd or 4th year post-treatment. Only one patient required salvage radiotherapy. Conclusion Transient swelling of VS following radiotherapy is generally an early phenomenon but may occur late. In the first 5 years, a true tumor progression cannot be differentiated from a pseudoprogression. A significant tumor expansion observed on 3 sequential MRI scans after the 3rd year may be suggestive of treatment failure. Long-term follow-up is therefore mandatory and no decision of salvage treatment should be made until the 6th year.
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Affiliation(s)
- O Fouard
- Neurosurgery Department, CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - J F Daisne
- Radiation Oncology Department, CHU UCL Namur Site Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium.,Radiation Oncology Department, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Oncology and Leuven Cancer Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Wanet
- Radiation Oncology Department, CHU UCL Namur Site Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium
| | - M Regnier
- Scientific Support Unit, CHU UCL Namur, Université catholique de Louvain, Namur, Belgium
| | - T Gustin
- Neurosurgery Department, CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
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Cesme DH, Alkan A, Sari L, Kaya A, Yurtsever I, Alkan G, Seyithanoglu MH, Hatiboglu MA. The Effectiveness of Diffusion Tensor Imaging in Determining Radiological Response after Radiosurgery in Patients with Vestibular Schwannoma. Curr Med Imaging 2021; 17:602-607. [PMID: 33504315 DOI: 10.2174/1573405617666210127160848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. OBJECTIVE The study aimed to determine the change in total tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigated the relationship between the TTV, follow-up times and DTI parameters. METHODS Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into three groups: those who responded to the treatment (group 1) (n=11), those who did not (group 0) (n=9) and those who remained stable (group 2) (n=11). RESULTS The mean duration of follow-up was 28.81±14 months. ADC values increased in patients with VS after radiosurgery (p=0.004). There was no statistical difference in the FA values. A significant reduction in TTV after radiosurgery was detected in group 1 (p=0.003). ADC values increased significantly after radiosurgery in group 2 (p=0.04). Although there were no significant differences, ADC values after radiosurgery increased in group 1 and group 0. CONCLUSIONS ADC values continuously increase due to radiation damage in the period before the tumor volume shrinks after radiosurgery. We think that it is not appropriate to diagnose inadequate treatment or progression only when TTV is evaluated in terms of response to treatment in the early period after radiosurgery.
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Affiliation(s)
- Dilek Hacer Cesme
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Kaya
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ismail Yurtsever
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Gokberk Alkan
- Department of Otorhinolaryngology Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Mustafa Aziz Hatiboglu
- Department of Neurosurgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Clinical outcomes of fractionated stereotactic radiosurgery in treating perioptic meningiomas and schwannomas: A single-institutional experience. J Clin Neurosci 2020; 81:409-415. [PMID: 33222952 DOI: 10.1016/j.jocn.2020.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/06/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
Application of radiosurgery to the newly diagnosed or post-operative residual perioptic lesions has been proved to improve tumor control. However, risk of vision injury induced by radiosurgery may increase substantially if the radiation dose is too high or tumor is close to the optic apparatus. The purpose of this study was to evaluate the safety and the effectiveness of fractionated stereotactic radiosurgery (FSRS) for perioptic tumors. We retrospectively analyzed 60 consecutive patients with 53 meningiomas and 7 schwannomas treated with FSRS between October 2007 and February 2020. We administered a marginal dose of 6-7 Gy (mean 6.8 Gy) per fraction and delivered 3 fractions in 3 consecutive days. The median tumor volume was 6.31 cm3 (range 0.3-58.23 cm3). The mean minimum lesion-optic distance (MLOD) is 0.85 mm (range 0-3 mm). After mean follow-up period of 69.6 months (range 6.82-156.32 months; median 58.9 months), the tumor control rates at 1, 3, 5, 8 and 13 years were 98.3%, 93.4%, 90.60%, 88.4% and 88.4%, respectively. Four out of the 60 tumors (6.7%) experienced a transient volume increase after FSRS. None of the patients developed visual impairment related to radiation induced optic neuropathy (RION) after FSRS. In conclusion, FSRS offers an alternative treatment option in treating perioptic meningiomas and schwannomas with acceptable tumor control rates and good visual preservation in the present study.
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Starnoni D, Giammattei L, Cossu G, Link MJ, Roche PH, Chacko AG, Ohata K, Samii M, Suri A, Bruneau M, Cornelius JF, Cavallo L, Meling TR, Froelich S, Tatagiba M, Sufianov A, Paraskevopoulos D, Zazpe I, Berhouma M, Jouanneau E, Verheul JB, Tuleasca C, George M, Levivier M, Messerer M, Daniel RT. Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162:2595-2617. [PMID: 32728903 PMCID: PMC7550309 DOI: 10.1007/s00701-020-04491-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. MATERIAL AND METHODS A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. RESULTS Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. CONCLUSION The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
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Affiliation(s)
- Daniele Starnoni
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | | | - Giulia Cossu
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Pierre-Hugues Roche
- Department of Neurosurgery, CHU North Hospital, Aix-Marseille University, Marseille, France
| | - Ari G Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Majid Samii
- Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Naples, NA, Italy
| | - Torstein R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | | | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Albert Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russian Federation; Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Tyumen, Russian Federation
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Idoya Zazpe
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, Spain
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Moncef Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - Jeroen B Verheul
- Department of Neurosurgery and Gamma knife Centre, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Constantin Tuleasca
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5) Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, Lausanne, Switzerland
| | - Mercy George
- ENT Service, Centre Hospitalier Universitaire Vaudois (CHUV); Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery Service and Gamma Knife Center, University hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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Rueß D, Pöhlmann L, Grau S, Hamisch C, Hoevels M, Treuer H, Baues C, Kocher M, Ruge M. Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system. Sci Rep 2020; 10:9309. [PMID: 32518238 PMCID: PMC7283483 DOI: 10.1038/s41598-020-66213-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/18/2020] [Indexed: 11/09/2022] Open
Abstract
Stereotactic radiosurgery (SRS) has evolved as widely accepted treatment option for small-sized (Koos I up to II) vestibular schwannoma (VS). For larger tumors (prevalent Koos VI), microsurgery or combined treatment strategies are mostly recommended. However, in patients not suited for microsurgery, SRS might also be an alternative to balance tumor control, hearing preservation and adverse effects. The purpose of this analysis was to evaluate the efficacy and toxicity of SRS for VS with regard to different Koos grades. All patients with untreated VS who received SRS at our center were included. Outcome analysis included tumor control, preservation of serviceable hearing based on median pure tone averages (PTA), and procedure-related adverse events rated by the Common Terminology Criteria for Adverse Events (CTCAE; v4.03) classification. In total, 258 patients (median age 58 years, range 21-84) were identified with a mean follow-up of 52 months (range 3-228 months). Mean tumor volume was 1.8 ml (range 0.1-18.5). The mean marginal dose was 12.3 Gy ± 0.6 (range 11-13.5). The cohort was divided into two groups: A (Koos grades I and II, n = 186) and B (Koos grades III and IV, n = 72). The actuarial tumor control rate was 98% after 2 years and 90% after 5 and 10 years. Koos grading did not show a significant impact on tumor control (p = 0.632) or hearing preservation (p = 0.231). After SRS, 18 patients (7%) had new transient or permanent symptoms classified by the CTCAE. The actuarial rate of CTCAE-free survival was not related to Koos grading (p = 0.093). Based on this selected population of Koos grade III and IV VS without or with only mild symptoms from brainstem compression, SRS can be recommended as the primary therapy with the advantage of low morbidity and satisfactory tumor control. The overall hearing preservation rate and toxicity of SRS was influenced by age and cannot be predicted by tumor volume or Koos grading alone.
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Affiliation(s)
- Daniel Rueß
- Department of Stereotaxy and functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
| | - Lea Pöhlmann
- Department of Stereotaxy and functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Stefan Grau
- Department of General Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Christina Hamisch
- Department of General Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Mauritius Hoevels
- Department of Stereotaxy and functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Harald Treuer
- Department of Stereotaxy and functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Christian Baues
- Institute of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Martin Kocher
- Department of Stereotaxy and functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Maximillian Ruge
- Department of Stereotaxy and functional Neurosurgery, Centre of Neurosurgery, University Hospital of Cologne, Cologne, Germany
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Fega KR, Fletcher GP, Waddle MR, Peterson JL, Ashman JB, Barrs DM, Bendok BR, Patel NP, Porter AB, Vora SA. Analysis of MRI Volumetric Changes After Hypofractionated Stereotactic Radiation Therapy for Benign Intracranial Neoplasms. Adv Radiat Oncol 2019; 4:43-49. [PMID: 30706009 PMCID: PMC6349623 DOI: 10.1016/j.adro.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 08/02/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023] Open
Abstract
Purpose To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. Methods and materials We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. Results Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). Conclusions HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist’s interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.
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Affiliation(s)
- Kathryn R Fega
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | | | - Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | - David M Barrs
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, Arizona
| | - Bernard R Bendok
- Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona
| | - Naresh P Patel
- Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
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Acoustic Neuroma Treated with Stereotactic Radiosurgery: Follow-up of 335 Patients. World Neurosurg 2018; 116:e194-e202. [DOI: 10.1016/j.wneu.2018.04.149] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/18/2022]
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Teo M, Zhang M, Li A, Thompson PA, Tayag AT, Wallach J, Gibbs IC, Soltys SG, Hancock SL, Chang SD. The Outcome of Hypofractionated Stereotactic Radiosurgery for Large Vestibular Schwannomas. World Neurosurg 2016; 93:398-409. [DOI: 10.1016/j.wneu.2016.06.080] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 11/30/2022]
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Lawson McLean AC, McLean AL, Rosahl SK. Evaluating vestibular schwannoma size and volume on magnetic resonance imaging: An inter- and intra-rater agreement study. Clin Neurol Neurosurg 2016; 145:68-73. [DOI: 10.1016/j.clineuro.2016.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/01/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
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