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Stereotactic radiosurgery ensures an effective and safe long-term control of Koos grade IV vestibular schwannomas: a single-center, retrospective, cohort study

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Abstract

Purpose

Stereotactic radiosurgery (SRS) is a standard treatment modality for vestibular schwannomas (VSs). However, there is a paucity of data on tumor control and neurological preservation for larger VSs. We aimed to investigate the long-term effectiveness of SRS for Koos grade IV compared with I-III VSs.

Methods

We included 452 patients with VSs (50 Koos grade IV and 402 Koos grade I‒III) who were treated with SRS at our institution from 1990 to 2021. Tumor control and functional preservation were calculated using the Kaplan–Meier method and compared between groups with the log-rank test.

Results

The median post-SRS follow-up period was 68 months. Progression-free survival rates were 91% at 5 and 10 years for Koos grade IV VSs, and 95% and 92%, respectively, for Koos grade I‒III VSs (p = 0.278). In Koos grade IV VSs, functional preservation rates of the facial and trigeminal nerves were both 96% at 5 years (both 98% for Koos grade I‒III VSs; facial, p = 0.410; trigeminal, p = 0.107). Hearing preservation rates were 61% at 5 years for Koos grade IV VSs and 78% for Koos grade I–III VSs (p = 0.645). Symptomatic transient tumor expansion was more common with Koos grade IV VSs (8.0% vs. 2.5%, p = 0.034), although all related symptoms diminished in accordance with tumor shrinkage.

Conclusion

SRS may contribute to long-term tumor control and adequate neurological preservation in the treatment of Koos grade IV VSs, comparable to those in the treatment of Koos grade I‒III VSs.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by JSPS KAKENHI (grant number 20K17919 to Yuki Shinya).

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Authors and Affiliations

  1. Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan

    Motoyuki Umekawa, Yuki Shinya, Hirotaka Hasegawa, Mariko Kawashima, Masahiro Shin & Nobuhito Saito

  2. Department of Radiology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan

    Atsuto Katano & Masanari Minamitani

  3. Department of Otorhinolaryngology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan

    Akinori Kashio & Kenji Kondo

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  1. Motoyuki Umekawa
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  2. Yuki Shinya
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Contributions

Conceptualization: MU and YS; Methodology: MUand YS; Formal analysis and investigation: MU and YS; Writing—original draft preparation: MU; Writing—review and editing: YS, HH, MK, MS, AK, MM, AK, KK, and NS; Funding acquisition: YS; Resources: YS, HH, AK, and MM; Supervision: NS.

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Correspondence to Yuki Shinya.

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The study was approved by the Institutional Review Board of The University of Tokyo Hospital (approval #2231) and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All patients provided written informed consent for study participation.

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Umekawa, M., Shinya, Y., Hasegawa, H. et al. Stereotactic radiosurgery ensures an effective and safe long-term control of Koos grade IV vestibular schwannomas: a single-center, retrospective, cohort study. J Neurooncol 159, 201–209 (2022). https://doi.org/10.1007/s11060-022-04058-9

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