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Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery

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Abstract

The pupose of this study is to assess the long-term outcome and toxicity of fractionated stereotactic radiation therapy (FSRT) and stereotactic radiosurgery (SRS) for 100 vestibular schwannomas treated at a single institution. From 1993 to 2007, 104 patients underwent were treated with radiation therapy for vestibular schwannoma. Forty-eight patients received SRS, with a median prescription dose of 12.5 Gy for SRS (range 9.7–16 Gy). For FSRT, two different fraction schedules were employed: a conventional schedule (ConFSRT) of 1.8 Gy per fraction (Gy/F) for 25 or 28 fractions to a total dose of 45 or 50.4 Gy (n = 19); and a once weekly hypofractionated course (HypoFSRT) consisting of 4 Gy/F for 5 fractions to a total dose of 20 Gy (n = 37). Patients treated with FSRT had better baseline hearing, facial, and trigeminal nerve function, and were more likely to have a diagnosis of NF2. The 5-year progression free rate (PFR) was 97.0 after SRS, 90.5 % after HypoFSRT, and 100.0 % after ConFSRT (p = NS). Univariate analysis demonstrated that NF2 and larger tumor size (greater than the median) correlated with poorer local control, but prior surgical resection did not. Serviceable hearing was preserved in 60.0 % of SRS patients, 63.2 % of HypoFSRT patients, and 44.4 % of ConFSRT patients (p = 0.6). Similarly, there were no significant differences in 5-year rates of trigeminal toxicity facial nerve toxicity, vestibular dysfunction, or tinnitus. Conclusions:Equivalent 5-year PFR and toxicity rates are shown for patients with vestibular schwanoma selected for SRS, HypoFSRT, and ConFSRT after multidisciplinary evaluation. Factors correlating with tumor progression included NF2 and larger tumor size.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Human Oncology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA

    Bethany M. Anderson, Søren M. Bentzen, Heather M. Geye, Lori L. Hayes, Amar Basavatia & Wolfgang A. Tomé

  2. Department of Neurological Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA

    John S. Kuo & Mustafa K. Baskaya

  3. Division of Otolaryngology, Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA

    G. Mark Pyle

  4. Department of Medical Physics, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA

    Wolfgang A. Tomé

  5. Western Radiation Oncology, 2500 Grant Road, Mountain View, CA, 94040, USA

    Deepak Khuntia

  6. Department of Neurosurgery, City of Hope Cancer Hospital, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Behnam Badie

  7. Department of Radiation Oncology, University of Maryland, 22 South Greene Street, Baltimore, MD, 21201, USA

    Minesh P. Mehta

Authors
  1. Bethany M. Anderson
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  2. Deepak Khuntia
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  3. Søren M. Bentzen
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  4. Heather M. Geye
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  6. John S. Kuo
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  7. Mustafa K. Baskaya
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  8. Behnam Badie
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  9. Amar Basavatia
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  11. Wolfgang A. Tomé
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  12. Minesh P. Mehta
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Correspondence to Bethany M. Anderson.

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Anderson, B.M., Khuntia, D., Bentzen, S.M. et al. Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery. J Neurooncol 116, 187–193 (2014). https://doi.org/10.1007/s11060-013-1282-4

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  • DOI: https://doi.org/10.1007/s11060-013-1282-4

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