Progressive Vestibular Schwannoma following Subtotal or Near-Total Resection: Dose-Escalated versus Standard-Dose Salvage Stereotactic Radiosurgery
| Autor: | David S. Haynes, Anthony J. Cmelak, Alexander D. Sherry, Alejandro Rivas, Albert Attia, Douglas J. Totten, Nauman F. Manzoor, Mohamed H. Khattab, Lola B. Chambless, Guozhen Luo |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Acoustic neuroma Schwannoma medicine.disease Effective dose (radiation) Radiosurgery Surgery 03 medical and health sciences Regimen 0302 clinical medicine 030220 oncology & carcinogenesis parasitic diseases Cohort medicine Neurology (clinical) business 030217 neurology & neurosurgery Progressive disease Cohort study |
| Zdroj: | J Neurol Surg B Skull Base |
| ISSN: | 2193-634X 2193-6331 |
| DOI: | 10.1055/s-0040-1712462 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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