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Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in young patients: a multi-institutional study

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Abstract

Purpose

Surgery is the treatment of choice for large vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has been suggested as an alternative to resection in selected patients. However, the safety and efficacy of SRS in Koos grade IV patients ≤ 45 years old has not been evaluated. The aim of this study is to describe the clinical and radiological outcomes of Koos grade IV in young patient managed with a single-session SRS.

Methods

This retrospective, multicenter analysis included SRS-treated patients, ≤ 45 years old presenting with non-life threatening or incapacitating symptoms due to a Koos Grade IV VS and with follow-up ≥ 12 months. Tumor control and neurological outcomes were evaluated.

Results

176 patients [median age of 36.0 (IQR 9) and median tumor volume of 9.3 cm3 (IQR 4.7)] were included. The median prescription dose was 12 Gy (IQR 0.5). Median follow-up period was 37.5 (IQR 53.5) months. The 5- and 10-year progression-free survival was 90.9% and 86.7%. Early tumor enlargement occurred in 10.9% of cases and was associated with tumor progression at the last follow-up. The probability of serviceable hearing preservation at 5- and 10-years was 56.8% and 45.2%, respectively. The probability of improvement or preservation of facial nerve function was 95.7% at 5 and 10-years. Adverse radiation effects were noted in 19.9%. New-onset hydrocephalus occurred in 4.0%.

Conclusion

Single-session SRS is a safe and effective alternative to surgical resection in selected patients ≤ 45 years old particularly those with medical co-morbidities and those who decline resection. Longer term follow up is warranted.

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Abbreviations

ARE:

Adverse radiation effect

CI:

Confident 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

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

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Chloe Dumot, Stylianos Pikis, Georgios Mantziaris, Zhiyuan Xu, 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. Department of Neurosurgery, Faculty of Medecine, Ain Shams University, Cairo, Egypt

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

  6. Department of Clinical Oncology, Faculty of Medecine, Ain Shams University, Cairo, Egypt

    Khaled Abdel Karim

  7. Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt

    Reem M. Emad Eldin

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

    Selcuk Peker & Yavuz Samanci

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

    Tehila Kaisman-Elbaz & Gene H. Barnett

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

    Herwin Speckter, Wenceslao Hernández & Julio Isidor

  11. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manjul Tripathi

  12. Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Renu Madan

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

    Brad E. Zacharia & Lekhaj C. Daggubati

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

    Nuria Martínez Moreno & Roberto Martínez Álvarez

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

    Anne-Marie Langlois & David Mathieu

  16. Department of Neurological Surgery, Emory University, Atlanta, Georgia

    Christopher P. Deibert

  17. Department of Neurosurgery, West Virginia University, Morgantown, WV, USA

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

  18. Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA

    Christopher P. Cifarelli

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

    Zhishuo Wei, Ajay Niranjan & L. Dade Lunsford

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

    Greg N. Bowden

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  1. Chloe Dumot
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Contributions

JPS,SP, DTC: conception and design, SP, GM, RKA, AMN, DS, KS, WAR, SRT, KAK, MNEl-S, RMEE, SP, YS, TK-E, HS, WH, JI, MT, RM, BEZ, LCD, NMM, RMÁ, AML, DM, CPD, VRS, CPC, DAI, ZW, AN, GHB, LDL, GNB: acquisition of data: CD, GM: analysis and interpretation of data, CD, SP: drafting the article, JPS, SP, GM, KAK, DM, VRS, DAI, LDL: critically revising the article, all authors: reviewed submitted version of manuscript, CD: statistical analysis, JPS: study supervision.

Corresponding author

Correspondence to Jason P. Sheehan.

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Conflict of interest

L. D. 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. C. P. Cifarelli has received speaking honoria from Carl Zeiss. 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 young patients: a multi-institutional study. J Neurooncol 160, 201–208 (2022). https://doi.org/10.1007/s11060-022-04134-0

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