Author:
Tuleasca Constantin,Kotecha Rupesh,Sahgal Arjun,de Salles Antonio,Fariselli Laura,Paddick Ian,Pollock Bruce E.,Régis Jean,Sheehan Jason,Suh John H.,Yomo Shoji,Levivier Marc
Abstract
Abstract
Purpose
To perform a systematic review of literature specific to single-fraction stereotactic radiosurgery (SRS) for large vestibular schwannomas (VS), maximum diameter ≥ 2.5 cm and/or classified as Koos Grade IV, and to present consensus recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS).
Methods
The Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. We considered eligible prospective and retrospective studies, written in the English language, reporting treatment outcomes for large VS; SRS for large post-operative tumors were analyzed in aggregate and separately.
Results
19 of the 229 studies initially identified met the final inclusion criteria. Overall crude rate of tumor control was 89% (93.7% with no prior surgery vs 87.7% with prior surgery). Rates of salvage microsurgical resection, need for shunt, and additional SRS in all series versus those with no prior surgery were 9.6% vs 3.3%, 4.7% vs 6.4% and 1% vs 0.9%, respectively. Rates of facial palsy and hearing preservation in all series versus those with no prior surgery were 1.3% vs 3.4% and 34.2% vs 40.4%, respectively.
Conclusions
Upfront SRS resulted in high rates of tumor control with acceptable rates of facial palsy and hearing preservation as compared to the results in those series including patients with prior surgery (level C evidence). Therefore, although large VS are considered classic indication for microsurgical resection, upfront SRS can be considered in selected patients and we recommend a prescribed marginal dose from 11 to 13 Gy (level C evidence).
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Neurology (clinical),Neurology,Oncology
Reference46 articles.
1. Tsao MN, Sahgal A, Xu W, De Salles A, Hayashi M, Levivier M, Ma L, Martinez R, Regis J, Ryu S, Slotman BJ, Paddick I (2017) Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline. J Radiosurg SBRT 5:5–24
2. Regis J, Carron R, Park MC, Soumare O, Delsanti C, Thomassin JM, Roche PH (2010) Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. J Neurosurg 113(Suppl):105–111. https://doi.org/10.3171/2010.8.GKS101058
3. Samii M, Gerganov VM, Samii A (2010) Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 112:860–867. https://doi.org/10.3171/2009.7.JNS0989
4. Samii M, Metwali H, Gerganov V (2016) Microsurgical management of vestibular schwannoma after failed previous surgery. J Neurosurg 125:1198–1203. https://doi.org/10.3171/2015.8.JNS151350
5. Carlson ML, Link MJ (2021) Vestibular Schwannomas. N Engl J Med 384:1335–1348. https://doi.org/10.1056/NEJMra2020394
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献