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Cancers (Basel). 2019 Oct 7;11(10). pii: E1498. doi: 10.3390/cancers11101498.

Long-Term Outcomes of Stereotactic Radiosurgery for Vestibular Schwannoma Associated with Neurofibromatosis Type 2 in Comparison to Sporadic Schwannoma.

Author information

1
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan. yukishinya6155@gmail.com.
2
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan. hirohasegawa-tky@umin.ac.jp.
3
Department of Neurologic Surgery, Mayo Clinic, MN 55905, USA. hirohasegawa-tky@umin.ac.jp.
4
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan. SHIN-NSU@h.u-tokyo.ac.jp.
5
Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo 162-8655, Japan. mrkawashima-tky@umin.ac.jp.
6
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan. mrkawashima-tky@umin.ac.jp.
7
Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan. mrkawashima-tky@umin.ac.jp.
8
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan. hnakatomi-tky@umin.ac.jp.
9
Department of Radiology, The University of Tokyo Hospital, Tokyo 113-8655, Japan. nsaito-tky@umin.net.
10
Department of Otorhinolaryngology, The University of Tokyo Hospital, Tokyo 113-8655, Japan. iwasaki-oto@h.u-tokyo.ac.jp.
11
Department of Otorhinolaryngology, The University of Tokyo Hospital, Tokyo 113-8655, Japan. kashioa-oto@h.u-tokyo.ac.jp.
12
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan. takehiro.sugiyama@gmail.com.
13
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan. wataru.harry1@gmail.com.

Abstract

The efficacy of radiosurgery for neurofibromatosis type 2 (NF2)-associated vestibular schwannoma (VS) remains debatable. We retrospectively analyzed radiosurgical outcomes for NF2-associated VS compared to sporadic VS using our database of 422 consecutive VS patients. Twenty-five patients with 30 NF2-associated VSs with a mean follow-up of 121 months were identified. NF2-associated VSs exhibited excellent tumor control (10-year cumulative rate, 92% vs. 92% in sporadic VSs; p = 0.945) and worse overall survival (73% vs. 97%; p = 0.005), mainly due to tumor progression other than the treated VSs. The presence of NF2 was not associated with failed tumor control via multivariate Cox proportional hazard analyses. No difference in radiation-induced adverse events (RAEs) was confirmed between cohorts, and prescription dose (hazard ratio 8.30, 95% confidence interval 3.19-21.62, p < 0.001) was confirmed as a risk for cranial nerve injuries via multivariate analysis. Further analysis after propensity score matching using age, volume, and sex as covariates showed that NF2-associated VSs exhibited excellent local control (100% vs. 93%; p = 0.240) and worse overall survival (67% vs. 100%; p = 0.002) with no significant difference in RAEs. Excellent long-term tumor control and minimal invasiveness may make radiosurgery a favorable therapeutic option for NF2 patients with small to medium VS, preferably with non-functional hearing or deafness in combination with postoperative tumor growth or progressive non-operated tumors, or with functional hearing by patients' wish.

KEYWORDS:

gamma knife radiosurgery; neurofibromatosis type 2; propensity score matching; stereotactic radiosurgery; tumor control; vestibular schwannoma

PMID:
31591325
DOI:
10.3390/cancers11101498
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