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J Neurol Surg B Skull Base
DOI: 10.1055/a-2620-0288
Original Article

Radiotherapy for Vestibular Schwannoma: Retrospective Cohort and Propensity Score Matching Analysis

Vinicius de Carvalho Gico
1   Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, Medical School of Sao Paulo University, Sao Paulo, SP, Brazil
,
Geovanne Pedro Mauro 
2   Department of Radiology and Oncology—Discipline of Radiotherapy, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Leila Maria Da Roz
3   Department of Neurology—Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Eduardo Weltman
2   Department of Radiology and Oncology—Discipline of Radiotherapy, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
4   Department of Radiation Oncology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
,
Evandro César De Souza
3   Department of Neurology—Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Rosangela Correa Villar
2   Department of Radiology and Oncology—Discipline of Radiotherapy, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo
3   Department of Neurology—Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Carlos Gilberto Carlotti
3   Department of Neurology—Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Abstract

Background

Surgery and stereotactic radiotherapy (SRT) are widely used for treating vestibular schwannomas (VS), but the impact of different SRT regimens remains debated. This study assesses outcomes of various SRT techniques in a large cohort.

Materials and Methods

Retrospective cohort of consecutive patients treated in a large academic hospital between 2008 and 2024. All patients were treated with LINAC-based SRT. The study compared outcomes between single-dose SRS (12–15 Gy), five-fraction SRS (total of 25 Gy), and conventionally fractionated SRT (50.4 Gy in 28 fractions). The main outcome was progression-free survival (PFS).

Results

The cohort included 197 patients, with a median age of 50.2 years, 65.5% of whom were female. The mean lesion size was 2.4 cm, and 61.4% of lesions were classified as high-class Koos (III and IV). Median follow-up was 54.0 months (6–142.1). Overall lesion control was 89.8% by RECIST 1.1 criteria, with no significant difference in PFS between the groups after propensity score matching. New hearing loss occurred in 14.7% of patients, whereas new facial palsy was reported in 3.0%. The presence of type-2 neurofibromatosis (NF2) was associated with poorer PFS (50.4 vs. 46.6 months, p = 0.002). Propensity score matching analysis was done and all regimens had similar PFS (matched sample size was 193, p = 0.808).

Conclusion

Different SRT regimens showed similar outcomes for lesion control and toxicity in VS patients, including those with NF2. This study supports LINAC-based SRT as a flexible treatment option, although further prospective studies are needed.

Keywords

schwannoma - radiosurgery - radiotherapy - stereotactic


Publication History

Received: 11 March 2025

Accepted: 22 May 2025

Article published online:
10 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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