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J Neurol Surg B Skull Base 2021; 82(S 03): e9-e14
DOI: 10.1055/s-0040-1712462
Original Article

Progressive Vestibular Schwannoma following Subtotal or Near-Total Resection: Dose-Escalated versus Standard-Dose Salvage Stereotactic Radiosurgery

Mohamed H. Khattab   *
1   Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Alexander D. Sherry  ‡   *
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Nauman Manzoor
3   Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Douglas J. Totten
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Guozhen Luo
1   Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Lola B. Chambless
4   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Alejandro Rivas
3   Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
David S. Haynes
3   Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Anthony J. Cmelak
1   Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Albert Attia
1   Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
4   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations 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.
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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.




Publication History

Received: 11 September 2019

Accepted: 19 March 2020

Article published online:
26 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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