Format

Send to

Choose Destination
Int J Radiat Oncol Biol Phys. 2018 Feb 1;100(2):443-451. doi: 10.1016/j.ijrobp.2017.09.024. Epub 2017 Sep 18.

Population-Based Study of Stereotactic Radiosurgery or Fractionated Stereotactic Radiation Therapy for Vestibular Schwannoma: Long-Term Outcomes and Toxicities.

Author information

1
Department of Radiation Therapy, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: alo3@bccancer.bc.ca.
2
Department of Radiation Therapy, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
3
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Therapy, BC Cancer Agency Abbotsford Centre, Abbotsford, British Columbia, Canada.
4
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Neurosurgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.
5
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Therapy, BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada.
6
Department of Radiation Therapy, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada.
7
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Therapy, BC Cancer Agency Vancouver Island Centre, Victoria, British Columbia, Canada.

Abstract

PURPOSE:

To examine long-term local control of vestibular schwannoma and side effects in patients treated with stereotactic radiosurgery (SRS) and fractionated stereotactic radiation therapy (SRT) in British Columbia.

METHODS AND MATERIALS:

From August 1998 to May 2009, 207 patients were treated with radiation therapy (RT) at British Columbia Cancer Agency. 136 (66%) received SRS, and 71 (34%) received SRT. Dose prescriptions were 50 Gy/25 fractions for SRT and 12 Gy/1 fraction for SRS. Our multidisciplinary provincial neuro-stereotactic conference recommended SRT for tumors >3 cm and for patients with serviceable hearing (Gardner-Robertson classes I and II).

RESULTS:

Median follow-up was 7.7 years to the last MRI and 6.4 years to the last clinical assessment. Local control for SRS versus SRT was 94% versus 87% at 5 years and 90% versus 85% at 10 years (P=.2). Five- and 10-year actuarial rates of RT-induced trigeminal nerve dysfunction were 25% and 25% after SRS, compared with 7% and 12% after SRT (P=.01). Five- and 10-year actuarial rates of RT-induced facial nerve dysfunction were 15% and 15% after SRS, versus 13% and 15% after SRT (P=.93). In the 49 patients with serviceable hearing at baseline who were treated with SRT, hearing preservation was 55% at 3 years, 37% at 5 years, and 29% at 7 years. In multivariable analysis, better pretreatment ipsilateral pure tone average was significantly associated with hearing preservation (hazard ratio 1.03; 95% confidence interval 1.00-1.07; P=.04).

CONCLUSIONS:

Both SRS and SRT provided excellent long-term local control of vestibular schwannoma. Stereotactic radiosurgery was associated with higher rates of trigeminal nerve dysfunction. Even with a fractionated course, hearing preservation declined steadily with long-term audiometric follow-up.

PMID:
29066124
DOI:
10.1016/j.ijrobp.2017.09.024
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center