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Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study

  • Original Article - Tumor - Schwannoma
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Abstract

Background

Surgery is the preferred treatment for large vestibular schwannomas (VS). Good tumor control and cranial nerve outcomes were described in selected Koos IV VS after single-session stereotactic radiosurgery (SRS), but outcomes in elderly patients have never been specifically studied. The aim of this study is to report clinical and radiological outcomes after single-session SRS for Koos IV VS in patients ≥ 65 years old.

Method

This multicenter, retrospective study included patients ≥ 65 years old, treated with primary, single-session SRS for a Koos IV VS, and at least 12 months of follow-up. Patients with life-threatening or incapacitating symptoms were excluded. Tumor control rate, hearing, trigeminal, and facial nerve function were studied at last follow-up.

Results

One-hundred and fifty patients (median age of 71.0 (IQR 9.0) years old with a median tumor volume of 8.3 cc (IQR 4.4)) were included. The median prescription dose was 12.0 Gy (IQR 1.4). The local tumor control rate was 96.0% and 86.2% at 5 and 10 years, respectively. Early tumor expansion occurred in 6.7% and was symptomatic in 40% of cases. A serviceable hearing was present in 16.1% prior to SRS and in 7.4% at a last follow-up of 46.5 months (IQR 55.8). The actuarial serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively. Facial nerve function preservation or improvement rates at 5 and 10 years were 98.7% and 91.0%, respectively. At last follow-up, the trigeminal nerve function was improved in 14.0%, stable in 80.7%, and worsened in 5.3% of the patients. ARE were noted in 12.7%. New hydrocephalus was seen in 8.0% of patients.

Conclusion

SRS can be a safe alternative to surgery for selected Koos IV VS in patients ≥ 65 years old. Further follow-up is warranted.

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Data Availability

The data that support the findings study are available from the corresponding author upon reasonable request.

Abbreviations

ARE:

Adverse radiation effect

CI:

Confidence interval

GR:

Gardner-Robertson

HB:

House-Brackmann

HR:

Hazard ratio

IRRF:

International Radiosurgery Research Foundation

SRS:

Stereotactic radiosurgery

VPS:

Ventriculoperitoneal shunt

VS:

Vestibular schwannoma

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Acknowledgements

Dr. Dumot gratefully acknowledges receipt of a grant for mobility from the Hospices civils de Lyon, France; from the Institut Servier, France; and from the Societe française of Neurochirurgie (SFNC), France, and for the Fondation Planiol, France.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health System, 1215 Leet Street, P.O. Box 800742, Charlottesville, VA, 22908-0742, USA

    Chloe Dumot, Stylianos Pikis, Georgios Mantziaris, Zhiyuan Xu, Sam Dayawansa, Rithika Kormath Anand, Darrah Sheehan, Kimball Sheehan & Jason P. Sheehan

  2. Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France

    Chloe Dumot

  3. Gamma Knife Center Cairo, Nasser Institute Cairo, Cairo, Egypt

    Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Khaled Abdel Karim, Amr M. N. El-Shehaby & Reem M. Emad Eldin

  4. Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt

    Ahmed M. Nabeel

  5. Departments of Neurosurgery and Clinical Oncology, Faculty of Medeine, Ain Shams University, Cairo, Egypt

    Wael A. Reda, Sameh R. Tawadros, Khaled Abdel Karim & Amr M. N. El-Shehaby

  6. Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

    Reem M. Emad Eldin

  7. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey

    Selcuk Peker & Yavuz Samanci

  8. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Tehila Kaisman-Elbaz & Gene H. Barnett

  9. Department of Radiology and Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic

    Herwin Speckter, Wenceslao Hernández & Julio Isidor

  10. Departments of Neurosurgery and Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manjul Tripathi & Renu Madan

  11. Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA, USA

    Brad E. Zacharia, Lekhaj C. Daggubati & Nuria Martínez Moreno

  12. Department of Radiosurgery, Rúber International Hospital, Madrid, Spain

    Roberto Martínez Álvarez

  13. Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada

    Anne-Marie Langlois & David Mathieu

  14. Department of Neurological Surgery, Emory University, Atlanta, GA, USA

    Christopher P. Deibert

  15. Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, WV, USA

    Vivek R. Sudhakar, Christopher P. Cifarelli, Denisse Arteaga Icaza & Daniel T. Cifarelli

  16. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA

    Zhishuo Wei, Ajay Niranjan & L. Dade Lunsford

  17. Department of Neurosurgery, University of Alberta, Edmonton, AB, Canada

    Greg N. Bowden

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  1. Chloe Dumot
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Contributions

Conception and design: JP Sheehan, Pikis, and DT Cifarelli. Acquisition of data: Pikis, Mantziaris, Kormath Anand, Nabeel, D Sheehan, K Sheehan, Reda, Tawadros, Abdelkarim, El-Shehaby, Emad Eldin, Peker, Samanci, Kaisman-Elbaz, Speckter, Hernández, Isidor, Tripathi, Madan, Zacharia, Daggubati, Martínez Moreno, Martínez Álvarez, Langlois, Mathieu, Deibert, Sudhakar, CP Cifarelli, Arteaga Icaza, Wei, Niranjan, Barnett, Lunsford, and Bowden. Analysis and interpretation of data: Dumot and Mantziaris. Drafting the article: Dumot and Pikis. Critically revising the article: JP Sheehan, Pikis, Mantziaris, Abdelkarim, Mathieu, Sudhakar, Arteaga Icaza, and Lunsford. Reviewed submitted version of manuscript: all authors. Statistical analysis: Dumot. Study supervision: JP Sheehan.

Corresponding author

Correspondence to Jason P. Sheehan.

Ethics declarations

Ethical approval

Each center obtained review board approval for the study and for sharing the de-identified patient database. Due to the retrospective nature of this study, written consent is not mandatory.

Conflict of interest

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Dr. Lunsford is a shareholder in Elekta AB, the manufacturer of some radiosurgical devices, a consultant for Teledoc Inc.. and a chair for Insightec’s data safety monitoring board. Dr. C. P. Cifarelli has received speaking honoria from Carl Zeiss. Dr. Zacharia is a consultant for Medtronic Inc. and a member of the speaker’s bureau of NICO Corp. and has ownership in Decentramed LLC.

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Dumot, C., Pikis, S., Mantziaris, G. et al. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study. Acta Neurochir 165, 211–220 (2023). https://doi.org/10.1007/s00701-022-05454-w

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