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Image-guided stereotactic radiotherapy for patients with vestibular schwannoma

A clinical study

Bild-geführte stereotaktische Radiotherapie für Patienten mit Vestibularis-Schwannomen

Eine klinische Studie

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Abstract

Introduction

Local tumor control and functional outcome after linac-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for vestibular schwannoma (VS) were assessed.

Methods

In all, 250 patients with VS were treated: 190 patients with tumors < 2 cm diameter underwent SRS and 60 patients with tumors >2 to 3.5 cm underwent FSRT. Dose prescription for all cases with SRS (n = 190, 76 %) was 13.5 Gy. For FSRT, mainly two hypofractionated schedules (n = 60, 24 %) with either 7 fractions of 5 Gy (total dose: 35 Gy; n = 35) or 11 fractions of 3.8 Gy (total dose: 41.8 Gy; n = 16) were used. The primary endpoint was local tumor control. Secondary endpoints were symptomatic control and morbidity.

Results

The median follow-up was 33.8 months. The 3-year local tumor control was 88.9 %. Local control for SRS and FSRT was 88 and 92 %, respectively. For FSRT with 35 and 41.8 Gy, local control was 90 and 100 %, respectively. There were no acute reactions exceeding grade I. In 61 cases (24.4 % of the entire cohort), trigeminal neuralgia was reported prior to treatment. At last follow-up, 16.3 % (10/61) of those patients reported relief of pain. Regarding facial nerve dysfunction, 45 patients (18 %) presented with symptoms prior to RT. At the last follow-up, 13.3% (6/45) of those patients reported a relief of dysesthesia.

Conclusion

Using SRS to treat small VS results in good local control rates. FSRT for larger lesions also seems effective. Severe treatment-related complications are not frequent. Therefore, image-guided stereotactic radiotherapy is an appropriate alternative to microsurgery for patients with VS.

Zusammenfassung

Einleitung

Wir analysierten die lokale Kontrolle und die funktionellen Verläufe bei Patienten mit einem Vestibularisschwannom (VS), die sich einer linacbasierten stereotaktischen Radiochirurgie (SRS) oder einer fraktionierten stereotaktischen Radiotherapie (FSRT) unterzogen.

Methoden

Zwischen 1998 und 2008 wurden 250 Patienten mit einem VS behandelt. In dieser Kohorte wurden 190 Fälle mit einem Tumor <2 cm mit SRS und 60 Fälle mit einem Tumor >2 cm bis 3,5 cm mit FSRT behandelt. Die verschriebene Dosis betrug für alle SRS-Fälle (n = 190, 76 %) 13,5 Gy im Isozentrum. Für die FSRT wurden zwei Schemata angewendet: 7 Fraktionen 5 Gy (Gesamtdosis 35 Gy; n = 35) und 11 Fraktionen 3,8 Gy (Gesamtdosis 41,8 Gy; n = 16). Der primäre Endpunkt war die lokale Kontrolle. Sekundäre Endpunkte waren Symptomkontrolle und Toxizität.

Ergebnisse

Nach einer medianen Nachuntersuchung von 33,8 Monaten betrug die 3-Jahres-Lokalkontrolle 88,9 % (bei 11,1 % Progress). Die lokale Kontrolle lag mit SRS bei 88 % und mit FSRT bei 92 %. Für die FSRT-Subgruppe betrug die lokale Kontrolle mit 35 Gy 90 % und mit 41,8 Gy 100 %. Kein Patient litt unter einer Toxizität vom Grad > 1. In 61 Fällen (24,4 % des Gesamtkollektivs) wurde vor der Therapie eine Trigeminusneuralgie berichtet, zur Zeit der Analyse litten noch 16,3 % (10/61) unter derselben. Eine Faszialisdysfunktion wiesen vor RT 45 Patienten (18 %) auf. Zum Follow-up-Zeitpunkt berichteten 13,3% (6/45) dieser Patienten von einer Linderung der Dysästhesie.

Schlussfolgerung

Die linacbasierte SRS zur Behandlung kleiner VS weist hohe lokale Kontrollraten auf, die vergleichbar mit der Mikrochirurgie sind. FSRT scheint auch für größere Läsionen effektiv. FSRT zeigt ebenfalls gute Ergebnisse in Bezug auf Sicherheit und Outcome. Ernsthafte behandlungsbedingte Nebenwirkungen sind nicht häufig. Der Vergleich von SRS und FSRT mit der Mikrochirurgie in Bezug auf Morbidität und Funktion der Hirnnerven zeigt eine Äquivalenz der Methoden. SRS kann für Patienten mit VS als eine gute Alternative zur Mikrochirurgie angesehen werden.

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References

  1. Sughrue ME, Yang I, Aranda D, Lobo K et al (2010) The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. J Neurosurg 112:163–167

    Google Scholar 

  2. Yamakami I, Uchino Y, Kobayashi E et al (2003) Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options. Neurol Res 25:682–690

    Google Scholar 

  3. Leksell L (1971) A note on the treatment of acoustic tumors. Acta Chir Scand 137:763–765

    Google Scholar 

  4. Murphy ES, Suh JH (2011) Radiotherapy for vestibular schwannomas: a critical review. Int J Radiat Oncol Biol Phys 79:985–989

    Google Scholar 

  5. Compter I, Zaugg K, Houben RM et al (2012) High symptom improvement and local tumor control using stereotactic radiotherapy when given early after diagnosis of meningioma. A multicentre study. Strahlenther Onkol 188):887–893

    Google Scholar 

  6. Runge MJ, Maarouf M, Hunsche S et al (2012) LINAC-radiosurgery for nonsecreting pituitary adenomas. Long-term results. Strahlenther Onkol 188:319–325

    Google Scholar 

  7. Fuetsch M, El Majdoub F, Hoevels M et al (2012) Stereotactic LINAC radiosurgery for the treatment of brainstem cavernomas. Strahlenther Onkol 188:311–316

    Google Scholar 

  8. Pannullo SC, Fraser JF, Moliterno J et al (2011) Stereotactic radiosurgery: a meta-analysis of current therapeutic applications in neuro-oncologic disease. J Neurooncol 103:1–17

    Google Scholar 

  9. Lunsford LD, Niranjan A, Flickinger JC et al (2005) Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 102(1 Suppl):195–199

    Google Scholar 

  10. Suh JH, Barnett GH, Sohn JW et al (2000) Results of linear accelerator-based stereotactic radiosurgery for recurrent and newly diagnosed acoustic neuromas. Int J Cancer 90:145–151

    Google Scholar 

  11. Foote KD, Friedman WA, Buatti JM et al (2001) Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 95:440–449

    Google Scholar 

  12. Spiegelmann R, Lidar Z, Gofman J et al (2001) Linear accelerator radiosurgery for vestibular schwannoma. J Neurosurg 94:7–13

    Google Scholar 

  13. Okunaga T, Matsuo T, Hayashi N et al (2005) Linear accelerator radiosurgery for vestibular schwannoma: measuring tumor volume changes on serial three-dimensional spoiled gradient-echo magnetic resonance images. J Neurosurg 103:53–58

    Google Scholar 

  14. Roos DE, Brophy BP, Bhat MK et al (2006) Update of radiosurgery at the Royal Adelaide Hospital. Australas Radiol 50:158–167

    Google Scholar 

  15. Combs SE, Thilmann C, Debus J et al (2006) Long-term outcome of stereotactic radiosurgery (SRS) in patients with acoustic neuromas. Int J Radiat Oncol Biol Phys 64:1341–1347

    Google Scholar 

  16. Rutten I, Baumert BG, Seidel L et al (2007) Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma. Radiother Oncol 82:83–89

    Google Scholar 

  17. Friedman WA, Bradshaw P, Myers A et al (2006) Linear accelerator radiosurgery for vestibular schwannomas. J Neurosurg 105:657–661

    Google Scholar 

  18. Kalogeridi MA, Georgolopoulou P, Kouloulias V et al (2009) Long-term results of LINAC-based stereotactic radiosurgery for acoustic neuroma: the Greek experience. J Cancer Res Ther 5:8–13

    Google Scholar 

  19. Williams JA (2002) Fractionated stereotactic radiotherapy for acoustic neuromas. Int J Radiat Oncol Biol Phys 54:500–504

    Google Scholar 

  20. Meijer OW, Vandertop WP, Baayen JC et al (2003) Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys 56:1390–1396

    Google Scholar 

  21. Sawamura Y, Shirato H, Sakamoto T et al (2003) Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 99:685–692

    Google Scholar 

  22. Selch MT, Pedroso A, Lee SP et al (2004) Stereotactic radiotherapy for the treatment of acoustic neuromas. J Neurosurg 101(Suppl 3):362–372

    Google Scholar 

  23. Combs SE, Volk S, Schulz-Ertner D et al (2005) Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): long-term results in 106 patients treated in single institution. Int J Radiat Oncol Biol Phys 63:75–81

    Google Scholar 

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Conflict of interest

H. Badakhshi, S. Muellner, E. Wiener, and V. Budach state that there are no conflicts of interest.

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Authors and Affiliations

  1. Departments for Radiation Oncology, Charité School of Medicine and University Hospital of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    H. Badakhshi, S. Muellner & V. Budach

  2. Institute for Neuroradiology, School of Medicine and University Hospital of Berlin, Berlin, Germany

    E. Wiener

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  1. H. Badakhshi
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  2. S. Muellner
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  3. E. Wiener
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  4. V. Budach
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Correspondence to H. Badakhshi.

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Badakhshi, H., Muellner, S., Wiener, E. et al. Image-guided stereotactic radiotherapy for patients with vestibular schwannoma. Strahlenther Onkol 190, 533–537 (2014). https://doi.org/10.1007/s00066-014-0646-9

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  • DOI: https://doi.org/10.1007/s00066-014-0646-9

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