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The impact of MRI steady-state sequences as an additional assessment modality in vestibular schwannoma patients after LINAC stereotactic radiotherapy or radiosurgery

Der Nutzen von MRT-Steady-State-Sequenzen als zusätzliche Auswertungsmethode bei Patienten mit Vestibularisschwannom nach LINAC-stereotaktischer Radiotherapie oder Radiochirurgie

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Abstract

Purpose

Data concerning the clinical usefulness of steady-state sequences (SSS) for vestibular schwannomas (VS) after linear accelerator (LINAC) stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are scarce. The aim of the study was to investigate whether SSS provide an additional useful follow-up (FU) tool to the established thin-layered T1 sequences with contrast enhancement.

Methods

Pre- and post-treatment SSS were identified in 45 consecutive VS patients (2012–2016) with a standardized FU protocol including SSS at 2–3 months and 6 months/yearly in our prospective database and were retrospectively re-evaluated. The SSS were used throughout for the segmentation of the cochlea and partly of the trigeminal nerve in the treatment planning. Data analysis included signal conversion in SSS and possible correlation with neuro-otological outcome and volumetric assessment after a certain time interval.

Results

The series included 42 SRS and 3 SRT patients (31 female/14 male; mean age 59.3 years, range: 25–81 years). An SSS signal conversion was observed in 20 tumors (44.4%) within a mean time of 11 months (range: 7–15 months). Mean FU time was 26 months (median of 4 FU visits) and demonstrated tumor volume shrinkage in 29 cases (64.4%) correlating with FU time (p = 0.07). The incidence rate of combined shrinkage and signal conversion (48.3%) compared to those without signal conversion (51.7%) did not differ significantly (p = 0.49). In case of an early signal conversion at the first FU, a weak statistical significance (p = 0.05) for a higher shrinkage rate of VS with signal conversion was found. Side effects in cases with signal conversion (9/20, 45%) were more frequently than without signal conversion (6/25, 24%) without reaching statistical significance (p = 0.13).

Conclusion

Our data confirmed the usefulness of SSS for anatomical segmentation of VS in LINAC-SRS/SRT treatment planning and add data supporting their potential as an adjunctive FU option in VS patients.

Zusammenfassung

Zielsetzung

Daten, die den klinischen Nutzen von Steady-State-Sequenzen (SSS) für Vestibularisschwannome (VS) nach einer LINAC („linear accelerator“) stereotaktischen Radiochirurgie (SRS) oder Radiotherapie (SRT) als Verlaufsparameter zeigen, sind selten. Ziel der Studie war es, zu untersuchen, ob SSS auch bei Follow-up(FU)-Untersuchungen neben den etablierten dünnschichtigen T1-Sequenzen mit Kontrastmittel nützlich sind.

Methoden

Bei 45 VS-Patienten (2012–2016) wurden SSS vor und nach Behandlung durchgeführt; ein standardisiertes FU-Schema sah SSS nach 2–3 Monaten, einem halben Jahr und jährlich vor. Die SSS wurden durchgehend für die Segmentierung der Cochlea und zum Teil auch des N. trigeminus bei der Bestrahlungsplanung eingesetzt. Die Ergebnisse wurden in einer prospektiven Datenbank erfasst und retrospektiv ausgewertet. Die Datenanalyse beinhaltete Signalkonversionen in den SSS und ihre möglichen Korrelationen mit neurootologischen Befunden und volumetrischen Veränderungen nach bestimmten Zeitintervallen.

Ergebnisse

Die Serie umfasste 42 SRS- und 3 SRT-Patienten (31 Frauen/14 Männer; mittleres Alter 59,3 Jahre; Spanne 25–81 Jahre). Eine SSS-Signalkonversion wurde in 20 Tumoren (44,4%) nach einem mittleren Zeitraum von 11 Monaten (Spanne 7–15 Monate) beobachtet. Die mittlere FU-Zeit betrug 26 Monate (mit einem Median von 4 FU-Terminen) und zeigte eine Tumorschrumpfung in 29 Fällen (64,4%), die mit der FU schwach korrelierte (p = 0,07). Die Häufigkeit des Auftretens von kombinierten Schrumpfungen und Signalkonversionen (48,3%) verglichen mit denen ohne Signalkonversion (51,7%) unterschied sich nicht signifikant (p = 0,49). Im Falle einer frühen Signalkonversion bereits bei der ersten FU konnte jedoch eine schwache statistische Signifikanz (p = 0,05) für eine höhere VS-Schrumpfungsrate festgestellt werden. Nebenwirkungen in Fällen mit Signalkonversion (9/20, 45%) waren etwas häufiger als bei Patienten ohne Signalkonversion (6/25, 24%), jedoch ohne statistische Signifikanz (p = 0,13).

Schlussfolgerung

Unsere Daten bestätigen den Nutzen von SSS für die anatomische Segmentierung von VS bei der LINAC-SRS/SRT-Behandlungsplanung und ergänzen Daten, die einen zusätzlichen Einsatz als nützliches FU-Instrument bei VS-Patienten rechtfertigen.

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Abbreviations

CTC:

Common Terminology Criteria for Adverse Events

FIESTA:

Fast imaging employing steady-state acquisition

FU:

Follow-up

GRE:

Gradient echo

LINAC:

Linear accelerator

SRS:

Stereotactic radiosurgery

SRT:

Stereotactic radiotherapy

SSS:

Steady-state sequences

VS:

Vestibular schwannoma

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Authors and Affiliations

  1. Department of Radiosurgery and Stereotactic Radiotherapy, MediClin Robert Janker Clinic and MediClin MVZ Bonn, Villenstraße 8, 53129, Bonn, Germany

    Julian P. Sauer &  Jan P. Boström MD

  2. Department of Neurosurgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Bogdan Pintea MD

  3. Department of Radiology and Neuroradiology, MediClin Robert Janker Clinic, Villenstraße 8, 53129, Bonn, Germany

    Andreas Schäfer

  4. Department of Neurosurgery, Division of Functional Neurosurgery, Stereotaxy and Neuromodulation, University Hospital of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Julian P. Sauer, Thomas M. Kinfe MD, Bogdan Pintea MD &  Jan P. Boström MD

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Correspondence to Jan P. Boström MD.

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J.P. Sauer, T.M. Kinfe, B. Pintea, A. Schäfer, and J.P. Boström declare that they have no competing interests.

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Sauer, J.P., Kinfe, T.M., Pintea, B. et al. The impact of MRI steady-state sequences as an additional assessment modality in vestibular schwannoma patients after LINAC stereotactic radiotherapy or radiosurgery. Strahlenther Onkol 194, 1103–1113 (2018). https://doi.org/10.1007/s00066-018-1317-z

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