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

Zwölfjahresergebnisse der LINAC-basierten Radiochirurgie für Vestibularisschwannome

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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.

Zusammenfassung

Ziel

Bericht der Langzeitergebnisse von 53 Patienten mit Vestibularisschwannomen (VS), die sich in unserer Einrichtung einer einzigen hochdosierten LINAC-Radiochirurgie (SRS) unterzogen haben.

Methoden

Insgesamt 48 (92%) Patienten waren für klinisches und Magnetresonanztomographie-(MRT-)Ansprechen sowie für spätere Toxizität auswertbar. Nach einem medianen Follow-up von 12 Jahren (Spanne 2–16 Jahre) wurden die lokale Kontrolle (LC), die Hörkapazität, die Trigeminus- und die Gesichtsnervenfunktion sowie die Toxizität bewertet. Die Hörkapazität wurde nach der Gardner-Robertson-Skala klassifiziert, in der die Patienten der Klasse I–II die Funktion „hörfähiges Hören“ hatten.

Ergebnisse

Die mittlere SRS-Dosis betrug 16,5 Gy (Spanne 13–20 Gy) und das mittlere Tumorvolumen 1,7 cm3 (Spanne 0,09–7,4 cm3). Es wurden 35 (73%) Patienten nur mit SRS behandelt, in den verbleibenden 13 (27%) wurde SRS als Salvage-Therapie für rezidivierende oder progressive Tumore durchgeführt. Vor der SRS hatte die Mehrheit der Patienten (92%) einen Hörverlust und 25 (52%) eine „unbrauchbare“ Hörfunktion. Die Tumorausbreitung, klassifiziert nach den Koos-Kategorien, war in 27 Fällen (56%) Grad I–II und in 21 (44%) Grad III–IV. Bei der MRT-Untersuchung lag die LC bei 100% und die Hörerhaltung bei Patienten mit „brauchbarer“ Hörfunktion bei 91%. Vier (11%) Patienten entwickelten eine unvollständige und intermittierende ipsilaterale Fazialisparese, die sich in einer mittleren Zeit von 6 Monaten zurückbildete. Die toxische Schädigung des N. trigeminus war reversibel bei 6 (13%) und dauerhaft bei 5 (10%) Patienten. Nur der Koos-Tumorgrad III–IV beeinflusste die spätere Toxizität signifikant (p = 0,01).

Schlussfolgerung

Die LC und Hörerhaltung nach SRS waren ausgezeichnet. Die Toxizität war akzeptabel. Obwohl die mittlere verabreichte Dosis (16,5 Gy) ziemlich hoch war, war der einzige Faktor, der die Spättoxizität signifikant beeinflusste, der Koos-Tumorgrad III–IV.

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Author information

Correspondence to Ernesto Maranzano MD.

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Conflict of interest

P. Anselmo, M. Casale, F. Arcidiacono, F. Trippa, R. Rispoli, L. Draghini, S. Terenzi, A. Di Marzo, and E. Maranzano declare that they have no competing interests.

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Anselmo, P., Casale, M., Arcidiacono, F. et al. Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas. Strahlenther Onkol 196, 40–47 (2020). https://doi.org/10.1007/s00066-019-01498-7

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Keywords

  • Vestibular schwannomas
  • Koos tumor grade
  • Radiosurgery
  • Late toxicity
  • Hearing preservation

Schlüsselwörter

  • Vestibularisschwannome
  • Koos-Tumorgrad
  • Radiochirurgie
  • Späte Toxizität