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Long-term clinical outcomes of stereotactic radiotherapy for bilateral vestibular schwannomas in neurofibromatosis type 2 patients

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Abstract

Purpose

The evidence for treating patients with neurofibromatosis 2-related vestibular schwannoma (VS-NF2) using hypofractionated stereotactic radiation therapy (HSRT) is limited. This study aimed to investigate clinical outcomes in patients with VS-NF2 treated with Robotic HSRT.

Methods

We retrospectively analyzed 25 NF2 patients with 48 VSs who were treated using Robotic HSRT at Ramathibodi Hospital from January 2009 to January 2020.

Results

Median follow-up was 98 months (range, 24–155 months). Median tumor volume was 2.3 cm3 (range, 0.4–28.3 cm3). Median prescribed dose was 18 Gy (range, 18–25 Gy) in three fractions (range, 3–5). The 5- and 10-year local control rates were 87% and 80%, respectively. The 5- and 10-year hearing preservation rates were 59% and 35%, respectively. Three patients developed new symptoms associated with transient volume expansion after treatment: hydrocephalus in one, facial weakness in one, and ataxia in one. No patient developed worsening of trigeminal nerve function. No histologically confirmed of radiation induced malignancy was reported in the study.

Conclusions

Robotic HSRT demonstrated excellent long-term tumor control with a low non-auditory complication rate in patients with VS-NF2. However, preservation of hearing remains a major concern.

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Data Availability

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

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Funding

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

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Authors and Affiliations

  1. Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Putipun Puataweepong, Mantana Dhanacha, Rawee Ruangkanchanasetr & Keeratikarn Boonyawan

  2. Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Ake Hansasuta & Kriangsak Saetia

  3. Radiosurgery Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Pornpan Yongvithisatid

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  1. Putipun Puataweepong
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Contributions

All authors contributed to the study conception and design. PP, MD, RR, KB, AH, KS and PY designed study, Material preparation, data collection and analysis were performed by PP, MD, RR, KB, AH, KS and PY. The first draft of the manuscript was written by PP and all authors commented of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Putipun Puataweepong.

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The authors declare no competing interests.

Ethics approval

The study was performed in the line with the principles of the Declaration of Helsinki. Approval was grant by the institutional review board of Ramathibodi Hospital.

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Puataweepong, P., Dhanacha, M., Ruangkanchanasetr, R. et al. Long-term clinical outcomes of stereotactic radiotherapy for bilateral vestibular schwannomas in neurofibromatosis type 2 patients. J Neurooncol 164, 587–595 (2023). https://doi.org/10.1007/s11060-023-04430-3

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