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Using the deformity index of vital structures to predict outcome of patients with large vestibular schwannomas after Gamma Knife radiosurgery

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Abstract

Purpose

Microsurgery is the mainstay of treatment for large vestibular schwannomas (VS), but the benefits of radiosurgery remain incompletely defined. Here, we aim to use automated volumetric analysis software to quantify the degree of brain stem deformity to predict long-term outcomes of patients with large VS following GKRS.

Methods

Between 2003 and 2020, 39 patients with large VS (volume > 8 cc) undergoing GKRS with a margin dose of 10–12 Gy were analyzed. The reconstruction 3D MRI was used to evaluate the extent of deformity for predicting the long-term outcome of patients.

Results

Their mean tumor volume was 13.7 ± 6.3 cc, and their mean follow-up after GKRS was 86.7 ± 65.3 months. Favorable clinical outcome was observed in 26 (66.7%) patients, while 13 (33.3%) patients had treatment failure. Patients with small tumor volumes, low vital structure deformity indice [(TV/(BSV + CerV) and (TV + EV)/(BSV + CerV)], and long distance of tumor to the central line were more likely to have favorable clinical outcome after GKRS. Significant prognostic value was with tumor shrinkage ratio (< 50%) were CV, CV/TV, TV/CerV, (TV + EV)/(BSV + CerV), and the distance of tumor to the central line. In cox regression, favorable clinical outcome was correlated with the Charlson comorbidity index and cochlear dosage (both p < 0.05). In multivariant analysis, tumor regression was highly correlated with the CV/TV ratio (p < 0.001).

Conclusions

The brainstem deformity ratio is likely a useful index to assess the clinical and tumor regression outcomes. Clinical outcomes are multifactorial and the tumor regression was highly correlated with the ratio of cystic components.

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Data Availability

Not applicable.

Abbreviations

VS:

vestibular schwannomas

GKRS:

gamma knife radiosurgery

Gy:

gray

MRI:

Magnetic Resonance Imaging

VP:

ventriculoperitoneal

SRS:

stereotactic radiosurgery

3D:

3-dimension

TOF:

time of flight

Gd:

Gadolinium

TV:

tumor volume

BSV:

brainstem volume

CerV:

cerebellum volume

CV:

cystic volume

EV:

edema volume

VV:

ventricle volume

TSR:

tumor shrinkage ratio

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Acknowledgements

The author would like to thank to the Biostatistics Task Force of Taichung Veterans General Hospital for their kind assistance in the statistical analysis.

Funding

This work was supported by the grant of TCVGH-PU1088103, TCVGH-1117303 C, and TCVGH-1117303D from Taichung Veterans General Hospital.

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Authors and Affiliations

  1. Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan

    Hao-Chun Chang

  2. Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan

    Weir Chiang You

  3. Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan

    Chiung-Chyi Shen, Ming-His Sun & Hung-Chuan Pan

  4. PhD program in Health and Social Welfare for Indigenous Peoples, Providence University, Taichung, Taiwan

    Ying Ju Chen

  5. Institute of Biomedical Sciences, National Chung-Hsing University, Taichung, Taiwan

    Meei-Ling Sheu

  6. Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Liang-Yi Pan

  7. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Jason Sheehan

  8. Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4 Taichung, 40705, Taichung, Taiwan ROC

    Kuo-Chih Su & Hung-Chuan Pan

  9. Ph.D. program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan

    Hung-Chuan Pan

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Contributions

HCC and WCY collected the data and drafted the manuscript. MLS, LYP and CCS participated in the study design. LYP and MHS participated in the data collection. MLS and JS participated in the study design and in the statistical analysis. KCS participated in the techniques of automatically calculation in volumetry study. JS participated in the study design and helped drafting the manuscript. HCP participated in the study design and coordination and helped to draft the manuscript. All authors read and approved the final manuscripts.

Corresponding author

Correspondence to Hung-Chuan Pan.

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Institute review board statement

This study was approved by the Ethical Committee of Taichung Veterans General Hospital (No. CE21156A).

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The authors declare no conflicts of interest in this study.

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Chang, HC., You, W.C., Shen, CC. et al. Using the deformity index of vital structures to predict outcome of patients with large vestibular schwannomas after Gamma Knife radiosurgery. J Neurooncol 162, 179–189 (2023). https://doi.org/10.1007/s11060-023-04280-z

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