Long-term outcomes of vestibular schwannomas treated with fractionated stereotactic radiotherapy: An institutional experience

Sumit Kapoor, Sachin Batra, Kathryn Carson, John Shuck, Siddharth Kharkar, Rahul Gandhi, Juan Jackson, Jan Wemmer, Stephanie Terezakis, Ori Shokek, Lawrence Kleinberg, Daniele Rigamonti

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

Purpose: We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma. Methods and Materials: Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radiotherapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms. Results: In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm 3 were 18.02 times more likely to progress than those with tumor volumes of 1 cm 3 or greater (odds ratio, 18.02; 95% confidence interval, 4.25-76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia. Conclusions: Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the "no salvage surgery needed" and "no additional treatment needed" criteria for treatment success need to be complemented by the radiologic data.

Original languageEnglish (US)
Pages (from-to)647-653
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume81
Issue number3
DOIs
StatePublished - Nov 1 2011

Keywords

  • Clinical outcomes
  • Fractionated stereotactic radiotherapy
  • Tumor progression
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Fingerprint

Dive into the research topics of 'Long-term outcomes of vestibular schwannomas treated with fractionated stereotactic radiotherapy: An institutional experience'. Together they form a unique fingerprint.

Cite this