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Safety and efficacy of fractionated stereotactic radiotherapy for acoustic neuromas

  • clinical-patient studies
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Abstract

Background: The treatment of acoustic neuromas (AN) has historically involved surgical excision or stereotactic radiosurgery, with a relatively limited number of reports available describing the use of fractionated stereotactic radiotherapy (FSRT). To enhance the existing knowledge regarding the safety and efficacy of this treatment modality, we describe our initial experience with FSRT for AN. Methods: From 1999–2005, 20 patients (12F, 8M) with AN underwent FSRT. All patients were treated using the Radionics X-Knife 4.0 3D planning system, receiving 54 Gy in 1.8 Gy daily fractions with a prescription isodose line of 90%. Treatments were delivered stereotactically using a dedicated Varian 6/100 linear accelerator, with immobilization achieved via the Gill-Thomas-Cosman relocatable frame. Median tumor size (maximum diameter) was 2.1 cm (range, 1.1–3.4 cm). Median patient age was 49.5 years, with median follow-up of 22 months (range, 1–66 months). All patients were evaluated with pre- and post-gadolinium-enhanced magnetic resonance imaging. Results: Following FSRT, local tumor control was achieved in every patient, with the treatment well-tolerated by all patients. No patient experienced acute complications or facial nerve weakness. Two patients experienced permanent trigeminal nerve morbidity manifesting as facial numbness. All nine patients with preserved hearing before treatment had hearing preservation at last follow-up, although four of these patients experienced hearing decline following FSRT. Conclusion: In our series of 20 patients with AN, all had local tumor control following FSRT, with minimal morbidity. These results support the growing body of literature demonstrating the safety and efficacy of FSRT in achieving local control for AN, further validating the viability of FSRT as a treatment modality for this patient population.

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Acknowledgment

We would like to thank Aleyna Perszyk-Dorr and Drs. Kwan Cho, Kathryn Dusenbery, Parham Alaei, Chung Lee, and Andrew Misselt for invaluable assistance.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Minnesota Medical School, 420 Delaware Street SE, Mayo Mail Code 96, Minneapolis, MN, 55455, USA

    Shearwood McClelland III & Walter A. Hall

  2. Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN, USA

    Bruce J. Gerbi, Patrick D. Higgins & James B. Orner

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  1. Shearwood McClelland III
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  2. Bruce J. Gerbi
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  3. Patrick D. Higgins
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  4. James B. Orner
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  5. Walter A. Hall
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Correspondence to Shearwood McClelland III.

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McClelland, S., Gerbi, B.J., Higgins, P.D. et al. Safety and efficacy of fractionated stereotactic radiotherapy for acoustic neuromas. J Neurooncol 86, 191–194 (2008). https://doi.org/10.1007/s11060-007-9456-6

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  • DOI: https://doi.org/10.1007/s11060-007-9456-6

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