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Acta Neurochirurgica
Published in: Acta Neurochirurgica 6/2017

Open Access 01-06-2017 | Review Article - Brain Tumors

Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review

Authors: Oscar Persson, Jiri Bartek Jr., Netanel Ben Shalom, Theresa Wangerid, Asgeir Store Jakola, Petter Förander

Published in: Acta Neurochirurgica | Issue 6/2017

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Abstract

Objective

Repeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) <3 cm in need of intervention. In this systematic review we aimed to compare results from single-fraction stereotactic radiosurgery (SRS) to fractionated stereotactic radiotherapy (FSRT) for patients with VS.

Data sources and eligibility criteria

We systematically searched MEDLINE, Web of Science, Embase and Cochrane and screened relevant articles for references. Publications from 1995 through 2014 with a minimum of 50 adult (>18 years) patients with unilateral VS, followed for a median of >5 years, were eligible for inclusion. After screening titles and abstracts of the 1094 identified articles and systematically reviewing 98 of these articles, 19 were included.

Intervention

Patients with unilateral VS treated with radiosurgery were compared to patients treated with fractionated stereotactic radiotherapy.

Results

No randomized controlled trial (RCT) was identified. None of the identified controlled studies comparing SRS with FSRT were eligible according to the inclusion criteria. Nineteen case series on SRS (n = 17) and FSRT (n = 2) were included in the systematic review. Loss of tumor control necessitating a new VS-targeted intervention was found in an average of 5.0% of the patients treated with SRS and in 4.8% treated with FSRT. Mean deterioration ratio for patients with serviceable hearing before treatment was 49% for SRS and 45% for FSRT, respectively. The risk for facial nerve deterioration was 3.6% for SRS and 11.2% for FSRT and for trigeminal nerve deterioration 6.0% for SRS and 8.4% for FSRT. Since these results were obtained from case series, a regular meta-analysis was not attempted.

Conclusion

SRS and FSRT are both noninvasive treatment alternatives for patients with VS with low rates of treatment failure in need of rescue therapy. In this selection of patients, the progression-free survival rates were on the order of 92–100% for both treatment options. There is a lack of high-quality studies comparing radiation therapy alternatives for patients with VS. Finally, 19 articles reported long-term tumor control after SRS, while only 2 articles reported long-term FSRT results, making effect estimates more uncertain for FSRT.
Appendix
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Literature
1.
Andrews DW, Suarez O, Goldman HW, Downes MB, Bednarz G, Corn BW, Werner-Wasik M, Rosenstock J, Curran WJ Jr (2001) Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50:1265–1278CrossRefPubMed
2.
Aoyama H, Onodera S, Takeichi N, Onimaru R, Terasaka S, Sawamura Y, Shirato H (2013) Symptomatic outcomes in relation to tumor expansion after fractionated stereotactic radiation therapy for vestibular schwannomas: single-institutional long-term experience. Int J Radiat Oncol Biol Phys 85:329–334CrossRefPubMed
3.
Barker FG 2nd, Carter BS, Ojemann RG, Jyung RW, Poe DS, McKenna MJ (2003) Surgical excision of acoustic neuroma: patient outcome and provider caseload. Laryngoscope 113:1332–1343CrossRefPubMed
4.
Barnett GH, Linskey ME, Adler JR, Cozzens JW, Friedman WA, Heilbrun MP, Lunsford LD, Schulder M, Sloan AE (2007) Stereotactic radiosurgery—an organized neurosurgery-sanctioned definition. J Neurosurg 106:1–5CrossRefPubMed
5.
Betchen SA, Walsh J, Post KD (2005) Long-term hearing preservation after surgery for vestibular schwannoma. J Neurosurg 102:6–9CrossRefPubMed
6.
Boari N, Bailo M, Gagliardi F, Franzin A, Gemma M, del Vecchio A, Bolognesi A, Picozzi P, Mortini P (2014) Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg 121(Suppl):123–142PubMed
7.
Brackmann DE, Owens RM, Friedman RA, Hitselberger WE, De la Cruz A, House JW, Nelson RA, Luxford WM, Slattery WH 3rd, Fayad JN (2000) Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol 21:417–424CrossRefPubMed
8.
Cerullo LJ, Grutsch JF, Heiferman K, Osterdock R (1993) The preservation of hearing and facial nerve function in a consecutive series of unilateral vestibular nerve schwannoma surgical patients (acoustic neuroma). Surg Neurol 39:485–493CrossRefPubMed
9.
Chan AW, Black P, Ojemann RG, Barker FG 2nd, Kooy HM, Lopes VV, McKenna MJ, Shrieve DC, Martuza RL, Loeffler JS (2005) Stereotactic radiotherapy for vestibular schwannomas: favorable outcome with minimal toxicity. Neurosurgery 57:60–70 discussion 60-70CrossRefPubMed
10.
Chopra R, Kondziolka D, Niranjan A, Lunsford LD, Flickinger JC (2007) Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 68:845–851CrossRefPubMed
11.
Choy W, Spasic M, Pezeshkian P, Fong BM, Nagasawa DT, Trang A, Mathur I, De Salles A, Gorgulho A, Selch M, Gopen QS, Yang I (2013) Outcomes of stereotactic radiosurgery and stereotactic radiotherapy for the treatment of vestibular schwannoma. Neurosurgery 60:120–125CrossRefPubMed
12.
Chung HT, Ma R, Toyota B, Clark B, Robar J, McKenzie M (2004) Audiologic and treatment outcomes after linear accelerator-based stereotactic irradiation for acoustic neuroma. Int J Radiat Oncol Biol Phys 59:1116–1121CrossRefPubMed
13.
Combs SE, Welzel T, Kessel K, Habermehl D, Rieken S, Schramm O, Debus J (2013) Hearing preservation after radiotherapy for vestibular schwannomas is comparable to hearing deterioration in healthy adults and is accompanied by local tumor control and a highly preserved quality of life (QOL) as patients’ self-reported outcome. Radiother Oncol J Eur Soc Ther Radiol Oncol 106:175–180CrossRef
14.
Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL (2015) Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas - pooled results from 3 large German centers. Radiother Oncol J Eur Soc Ther Radiol Oncol 114:378–383CrossRef
15.
Fukuoka S, Takanashi M, Hojyo A, Konishi M, Tanaka C, Nakamura H (2009) Gamma Knife radiosurgery for vestibular schwannomas. Prog Neurol Surg 22:45–62CrossRefPubMed
16.
Hasegawa T, Kida Y, Kato T, Iizuka H, Kuramitsu S, Yamamoto T (2013a) Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 118:557–565CrossRefPubMed
17.
Hasegawa T, Kida Y, Kobayashi T, Yoshimoto M, Mori Y, Yoshida J (2013b) Long-term outcomes in patients with vestibular schwannomas treated using Gamma Knife surgery: 10-year follow up. J Neurosurg 119(Suppl):10–16PubMed
18.
Hayhurst C, Zadeh G (2012) Tumor pseudoprogression following radiosurgery for vestibular schwannoma. Neuro-Oncology 14:87–92CrossRefPubMed
19.
Hempel JM, Hempel E, Wowra B, Schichor C, Muacevic A, Riederer A (2006) Functional outcome after Gamma Knife treatment in vestibular schwannoma. Eur Arch Otorhinolaryngol 263:714–718CrossRefPubMed
20.
Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration
21.
22.
Iwai Y, Yamanaka K, Shiotani M, Uyama T (2003) Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53:282–287 discussion 287-288CrossRefPubMed
23.
Karpinos M, Teh BS, Zeck O, Carpenter LS, Phan C, Mai WY, Lu HH, Chiu JK, Butler EB, Gormley WB, Woo SY (2002) Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54:1410–1421CrossRefPubMed
24.
Kim YH, Kim DG, Han JH, Chung HT, Kim IK, Song SW, Park JH, Kim JW, Kim YH, Park CK, Kim CY, Paek SH, Jung HW (2013) Hearing outcomes after stereotactic radiosurgery for unilateral intracanalicular vestibular schwannomas: implication of transient volume expansion. Int J Radiat Oncol Biol Phys 85:61–67CrossRefPubMed
25.
Kondziolka D, Shin SM, Brunswick A, Kim I, Silverman JS (2015) The biology of radiosurgery and its clinical applications for brain tumors. Neuro-Oncology 17:29–44CrossRefPubMed
26.
Kopp C, Fauser C, Muller A, Astner ST, Jacob V, Lumenta C, Meyer B, Tonn JC, Molls M, Grosu AL (2011) Stereotactic fractionated radiotherapy and LINAC radiosurgery in the treatment of vestibular schwannoma—report about both stereotactic methods from a single institution. Int J Radiat Oncol Biol Phys 80:1485–1491CrossRefPubMed
27.
Lin D, Hegarty JL, Fischbein NJ, Jackler RK (2005) The prevalence of “incidental” acoustic neuroma. Arch Otolaryngol Head Neck Surg 131:241–244CrossRefPubMed
28.
Litre F, Rousseaux P, Jovenin N, Bazin A, Peruzzi P, Wdowczyk D, Colin P (2013) Fractionated stereotactic radiotherapy for acoustic neuromas: a prospective monocenter study of about 158 cases. Radiother Oncol J Eur Soc Ther Radiol Oncol 106:169–174CrossRef
29.
Liu D, Xu D, Zhang Z, Zhang Y, Zheng L (2006) Long-term outcomes after Gamma Knife surgery for vestibular schwannomas: a 10-year experience. J Neurosurg 105(Suppl):149–153PubMed
30.
Lobato-Polo J, Kondziolka D, Zorro O, Kano H, Flickinger JC, Lunsford LD (2009) Gamma Knife radiosurgery in younger patients with vestibular schwannomas. Neurosurgery 65:294–300 discussion 300-291CrossRefPubMed
31.
Massick DD, Welling DB, Dodson EE, Scholfield M, Nagaraja HN, Schmalbrock P, Chakeres DW (2000) Tumor growth and audiometric change in vestibular schwannomas managed conservatively. Laryngoscope 110:1843–1849CrossRefPubMed
32.
Meijer OWM, Vandertop WP, Baayen JC, Slotman BJ (2003) Single-fraction vs. fractionated LINAC-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys 56:1390–1396CrossRefPubMed
33.
Mindermann T, Schlegel I (2014) How to distinguish tumor growth from transient expansion of vestibular schwannomas following Gamma Knife radiosurgery. Acta Neurochir 156:1121–1123CrossRefPubMed
34.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clin Res Ed) 339:b2535CrossRef
35.
36.
Myrseth E, Moller P, Pedersen PH, Vassbotn FS, Wentzel-Larsen T, Lund-Johansen M (2005) Vestibular schwannomas: clinical results and quality of life after microsurgery or Gamma Knife radiosurgery. Neurosurgery 56:927–935 discussion 927-935PubMed
37.
Myrseth E, Pedersen PH, Moller P, Lund-Johansen M (2007) Treatment of vestibular schwannomas. Why, when and how? Acta Neurochir 149:647–660 discussion 660CrossRefPubMed
38.
Myrseth E, Moller P, Pedersen PH, Lund-Johansen M (2009) Vestibular schwannoma: surgery or Gamma Knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 64:654–661 discussion 661-653CrossRefPubMed
39.
Nagano O, Serizawa T, Higuchi Y, Matsuda S, Sato M, Yamakami I, Okiyama K, Ono J, Saeki N (2010) Tumor shrinkage of vestibular schwannomas after Gamma Knife surgery: results after more than 5 years of follow-up. J Neurosurg 113(Suppl):122–127PubMed
40.
Nakazawa H, Mori Y, Komori M, Shibamoto Y, Tsugawa T, Kobayashi T, Hashizume C (2014) Validation of accuracy in image co-registration with computed tomography and magnetic resonance imaging in Gamma Knife radiosurgery. J Radiat Res 55:924–933CrossRefPubMedPubMedCentral
41.
Pawlik TM, Keyomarsi K (2004) Role of cell cycle in mediating sensitivity to radiotherapy. Int J Radiat Oncol Biol Phys 59:928–942CrossRefPubMed
42.
Pollock BE, Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Kelsey SF, Jannetta PJ (1995) Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 36:215–224 discussion 224-219CrossRefPubMed
43.
Pollock BE, Driscoll CL, Foote RL, Link MJ, Gorman DA, Bauch CD, Mandrekar JN, Krecke KN, Johnson CH (2006) Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 59:77–85 discussion 77-85CrossRefPubMed
44.
Pollock BE, Link MJ, Foote RL (2013) Failure rate of contemporary low-dose radiosurgical technique for vestibular schwannoma. Clinical article. J Neurosurg 119(Suppl):840–844PubMed
45.
Puataweepong P, Dhanachai M , Dangprasert S, Narkwong L, Sitathanee C, Sawangsilpa T, Janwityanujit T, Yongvithisatid P, (2014) Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas: comparative observations of 139 patients treated at a single institution. J Radiat Res 55:351-358
46.
Regis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, Zanaret M, Peragut JC (2002) Functional outcome after Gamma Knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:1091–1100CrossRefPubMed
47.
Regis J, Tamura M, Delsanti C, Roche PH, Pellet W, Thomassin JM (2008) Hearing preservation in patients with unilateral vestibular schwannoma after Gamma Knife surgery. Prog Neurol Surg 21:142–151CrossRefPubMed
48.
Roos DE, Potter AE, Zacest AC (2011) Hearing preservation after low dose LINAC radiosurgery for acoustic neuroma depends on initial hearing and time. Radiother Oncol J Eur Soc Ther Radiol Oncol 101:420–424CrossRef
49.
Stangerup SE, Caye-Thomasen P (2012) Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin N Am 45:257–268 viiCrossRef
50.
Sun S, Liu A (2012) Long-term follow-up studies of Gamma Knife surgery with a low margin dose for vestibular schwannoma. J Neurosurg 117(Suppl):57–62PubMed
51.
Tsai JT, Lin JW, Lin CM, Chen YH, Ma HI, Jen YM, Chen YH, Ju DT (2013) Clinical evaluation of CyberKnife in the treatment of vestibular schwannomas. Biomed Res Int 2013:297093CrossRefPubMedPubMedCentral
52.
Unger F, Walch C, Papaefthymiou G, Eustacchio S, Feichtinger K, Quehenberger F, Pendl G (2002) Long term results of radiosurgery for vestibular schwannomas. Zentralbl Neurochir 63:52–58CrossRefPubMed
53.
Wangerid T, Bartek J Jr, Svensson M, Forander P (2014) Long-term quality of life and tumour control following Gamma Knife radiosurgery for vestibular schwannoma. Acta Neurochir 156:389–396CrossRefPubMed
54.
Wangerid T, Benmakhlouf H, Grane P, Bartek J Jr, Svensson M, Forander P (2015) Implication of using MRI co-registered with CT in Leksell Gamma Knife® dose planning for patients with vestibular schwannoma. Clin Neurol Neurosurg 138:10–15CrossRefPubMed
55.
Wolbers JG, Dallenga AH, Mendez Romero A, van Linge A (2013) What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open 3:e001345CrossRefPubMedPubMedCentral
56.
Yomo S, Carron R, Thomassin JM, Roche PH, Regis J (2012) Longitudinal analysis of hearing before and after radiosurgery for vestibular schwannoma. J Neurosurg 117:877–885CrossRefPubMed
Metadata
Title
Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review
Authors
Oscar Persson
Jiri Bartek Jr.
Netanel Ben Shalom
Theresa Wangerid
Asgeir Store Jakola
Petter Förander
Publication date
01-06-2017
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 6/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3164-6

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