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Modern Gamma Knife radiosurgery of vestibular schwannomas: treatment concept, volumetric tumor response, and functional results

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Abstract

The objective of the present study was longitudinal evaluation of the volumetric tumor response and functional results after Gamma Knife radiosurgery of vestibular schwannomas, performed according to the modern standards of treatment. From October 2003 to September 2007, 133 consecutive patients with vestibular schwannomas were treated according to the concept of robotic Gamma Knife microradiosurgery, which is based on precise irradiation of the lesion, sparing adjacent structures, and delivery of the high radiation energy to the target. Multiple small-sized isocenters located within the border of the neoplasm were applied. The mean marginal dose was 11.5 Gy (range, 11–12 Gy). In total, 126 cases with a minimum posttreatment follow-up of 2 years (range, 2–7 years; median, 4 years) were analyzed. Temporary enlargement was noted in 25 % of tumors at 6 months after radiosurgery. At 3 years of follow-up, tumor shrinkage, stabilization, and increase in volume were marked in 73 %, 23 %, and 4 % of cases, respectively. All progressing lesions spontaneously stabilized later on and did not require additional management. In 3 % of patients, transitory impairment of the facial nerve function was marked; however, neither its permanent dysfunction nor trigeminal neuropathy attributed to radiosurgery was noted. Impairment of hearing compared to its pretreatment level was revealed in 4 %, 12 %, 13 %, and 16 % of patients at 6 months, 1 year, 2 years, and 3 years after radiosurgery, respectively, and this trend was statistically significant (P = 0.0042). Overall, 77 % of patients with serviceable hearing before treatment preserved it 3 years thereafter. In conclusion, modern Gamma Knife radiosurgery provides effective and safe management of vestibular schwannomas. Nevertheless, possible temporary tumor enlargement, delay of its growth arrest, transient dysfunction of the cranial nerves, and gradual deterioration of hearing after irradiation should be always taken into consideration.

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Acknowledgments

Dr. Samuel M. Lipski had training fellowship in the Gamma Knife Unit of the Tokyo Women’s Medical University from October to November 2009. This study represents a part of the Innovative Project of ELEKTA Research Collaboration with Tokyo Women’s Medical University/TWIns.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Samuel M. Lipski, Motohiro Hayashi, Mikhail Chernov & Yoshikazu Okada

  2. Faculty of Advanced Techno-Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Motohiro Hayashi & Mikhail Chernov

  3. Department of Ear, Nose, and Throat, Tivoli University Hospital, La Louviere, Belgium

    Samuel M. Lipski

  4. Department of Neurosurgery and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland

    Marc Levivier

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  1. Samuel M. Lipski
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  2. Motohiro Hayashi
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  3. Mikhail Chernov
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  4. Marc Levivier
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  5. Yoshikazu Okada
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Correspondence to Motohiro Hayashi.

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Comments

Ryojo Akagami, Vancouver, Canada

The authors describe their experience using “robotic Gamma Knife microradiosurgery” concept for management of vestibular schwannomas, documenting very good outcomes with volumetric measurements over a median follow-up of 4 years. Through their outcomes, the authors show that there are improvements in radiosurgery techniques.

The authors point out that this is a “non-selected” series of patients where pretreatment growth or growth rate was not taken into consideration. There are no comparison (apart from previous studies), with natural history.

Although the paper adds to the fund of reports for radiation treatments, especially using newer technology, median follow-up of 4 years is still quite short for a benign tumor, and we know from good natural history studies that a significant proportion of these tumors do not seem to grow after diagnosis.

We have experienced delayed significant progression requiring salvage surgery >10 years after initial radiosurgery treatment; if percentage of tumors likely to grow after diagnosis is selected from one of the natural history studies, a “corrected” control rate could be easily calculated using simple arithmetic.

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Lipski, S.M., Hayashi, M., Chernov, M. et al. Modern Gamma Knife radiosurgery of vestibular schwannomas: treatment concept, volumetric tumor response, and functional results. Neurosurg Rev 38, 309–318 (2015). https://doi.org/10.1007/s10143-014-0601-3

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