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Clin Neurol Neurosurg. 2018 Mar;166:116-123. doi: 10.1016/j.clineuro.2018.01.005. Epub 2018 Jan 12.

Hypo-fractionated stereotactic radiotherapy of five fractions with linear accelerator for vestibular schwannomas: A systematic review and meta-analysis.

Author information

1
Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States; David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, United States.
2
Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States.
3
Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, United States.
4
Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States.
5
Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States; Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, United States.
6
Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States; Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States; Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, United States; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, United States; Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, United States; Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, United States; David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, United States. Electronic address: iyang@mednet.ucla.edu.

Abstract

Vestibular schwannomas (VS) are benign tumors stemming from the eighth cranial nerve. Treatment options for VS include conservative management, microsurgery, stereotactic radiosurgery, and fractionated radiotherapy. Though microsurgery has been the standard of care for larger lesions, hypo-fractionated stereotactic radiotherapy (hypo-FSRT) is an emerging modality. However, its clinical efficacy and safety have yet to be established. We conducted a systematic review and meta-analysis of manuscripts indexed in PubMed, Scopus, Web of Science, Embase, and Cochrane databases reporting outcomes of VS cases treated with hypo-FSRT. Five studies representing a total of 228 patients were identified. Across studies, the pooled rates of tumor control, hearing, facial nerve, and trigeminal nerve preservation were 95%, 37%, 97%, and 98%. No instances of malignant induction were observed at median follow-up of 34.8 months. Complications included trigeminal neuropathy (n = 3), maxillary paresthesia (n = 1), neuralgia (n = 1), vestibular dysfunction (n = 1), radionecrosis (n = 1), and hydrocephalus (n = 1). Hypo-FSRT may be another useful approach to manage VS, but studies with extended follow-up times are required to establish long-term safety.

KEYWORDS:

Acoustic neuroma; Fractionated stereotactic radiosurgery; Radiotherapy; Vestibular schwannoma

PMID:
29414150
DOI:
10.1016/j.clineuro.2018.01.005
[Indexed for MEDLINE]

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