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DOI: 10.1055/s-0040-1712462
Progressive Vestibular Schwannoma following Subtotal or Near-Total Resection: Dose-Escalated versus Standard-Dose Salvage Stereotactic Radiosurgery
Funding Mohamed H. Khattab receives research funding from Varian Medical Systems and Brainlab. Alejandro Rivas is a consultant for Advanced Bionics, MED-EL, Cochlear Corporation, Cook Medical, Grace Medical, and Stryker. David S. Haynes is a consultant for Stryker, Cochlear Corporation, MED-EL, and Advanced Bionics. Albert Attia receives funding from Brainlab, AstraZeneca, and Novocure.![](https://www.thieme-connect.de/media/jnlsb/2021S03/lookinside/thumbnails/10-1055-s-0040-1712462_190235-1.jpg)
Abstract
Objective Local failure of incompletely resected vestibular schwannoma (VS) following salvage stereotactic radiosurgery (SRS) using standard doses of 12 to 13 Gy is common. We hypothesized that dose-escalated SRS, corrected for biologically effective dose, would have superior local control of high-grade VS progressing after subtotal or near-total resection compared with standard-dose SRS.
Design Retrospective cohort study.
Setting Tertiary academic referral center.
Participants Adult patients treated with linear accelerator-based SRS for progressive VS following subtotal or near-total resection.
Main Outcome Measures Dose-escalated SRS was defined by a biologically effective dose exceeding a single-fraction 13-Gy regimen. Study outcomes were local control and neurologic sequelae of SRS. Binary logistic regression was used to evaluate predictors of study outcomes.
Results A total of 18 patients with progressive disease following subtotal (71%) and near-total (39%) resection of Koos grade IV disease (94%) were enrolled. Of the 18 patients, 7 were treated with dose-escalated SRS and 11 with standard-dose SRS. Over a median follow-up of 32 months after SRS, local control was 100% in the dose-escalated cohort and 91% in the standard-dose cohort (p = 0.95). Neurologic sequelae occurred in 28% of patients, including 60% of dose-escalated cohort and 40% of the standard-dose cohort (p = 0.12), although permanent neurologic sequelae were low at 6%.
Conclusions Dose-escalated SRS has similar local control of recurrent VS following progression after subtotal or near-total resection and does not appear to have higher neurologic sequalae. Larger studies are needed.
Keywords
vestibular schwannoma - stereotactic radiosurgery - outcomes - radiation dose - progression - cohort - salvage - acoustic neuroma* These authors contributed equally.
Publikationsverlauf
Eingereicht: 11. September 2019
Angenommen: 19. März 2020
Artikel online veröffentlicht:
26. Mai 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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