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01-01-2020 | Vestibular Schwannoma | Original Article

Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas

Authors: Paola Anselmo, MD, Michelina Casale, PhD, Fabio Arcidiacono, MD, Fabio Trippa, MD, Rossella Rispoli, MD, Lorena Draghini, MD, Sara Terenzi, MD, Alessandro Di Marzo, MD, Ernesto Maranzano, MD

Published in: Strahlentherapie und Onkologie | Issue 1/2020

Abstract

Purpose

To report long-term outcomes of 53 patients with vestibular schwannomas (VS) submitted to a single high-dose LINAC-based radiosurgery (SRS) in our institution.

Methods

48 (92%) patients were evaluable for clinical and MRI response as well as late toxicity. At a median follow-up of 12 years (range 2–16 years), local control (LC), hearing capacity, trigeminal and facial nerve function, and toxicity were assessed. Hearing capacity was classified according to the Gardner–Robertson scale, where class I–II patients had “serviceable hearing.”

Results

Median dose of SRS was 16.5 Gy (range 13–20 Gy) and median tumor volume 1.7 cm³ (range 0.09–7.4 cm³). 35 (73%) patients were treated with SRS alone, in the remaining 13 (27%) patients, SRS was performed as salvage therapy for recurrent or progressive tumors after previous microsurgery. Before SRS, 44 patients (92%) had hearing loss and 25 (52%) had “non-serviceable” hearing. Tumor extension, classified with Koos categories, was grade I–II in 27 (56%) and grade III–IV in 21 (44%) cases. LC was 100% and hearing preservation in “serviceable hearing” patients was 91%. 4 (11%) patients developed incomplete and intermittent ipsilateral facial nerve palsy which regressed in a median time of 6 months. Trigeminal toxicity was registered in 11 (23%) patients, reversible in 6 (13%) and permanent in 5 (10%). Only Koos tumor grade III–IV significantly influenced late toxicity (p = 0.01).

Conclusion

LC and hearing preservation after SRS were excellent. Toxicity proved acceptable. Although the median administered dose (16.5 Gy) was rather high, the only factor which significantly influenced late toxicity was Koos tumor grade III–IV.

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Title: Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas
Authors: Paola Anselmo, MD
Michelina Casale, PhD
Fabio Arcidiacono, MD
Fabio Trippa, MD
Rossella Rispoli, MD
Lorena Draghini, MD
Sara Terenzi, MD
Alessandro Di Marzo, MD
Ernesto Maranzano, MD
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Vestibular Schwannoma
Vestibular Schwannoma
Published in: Strahlentherapie und Onkologie / Issue 1/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-019-01498-7

At a glance: The STEP trials

Springer Medicine

Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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