J Neurol Surg B Skull Base 2017; 78(01): 002-010
DOI: 10.1055/s-0036-1584231
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Low-Dose Gamma Knife Radiosurgery for Vestibular Schwannomas: Tumor Control and Cranial Nerve Function Preservation After 11 Gy

Andrew J. Schumacher
1   Department of Radiation Oncology, Kaiser Permanente, Los Angeles, California, United States
,
Rohan R. Lall
2   Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Rishi R. Lall
3   Department of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas, United States
,
Allan Nanney III
2   Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Amit Ayer
2   Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Samir Sejpal
4   Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Benjamin P. Liu
5   Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Maryanne Marymont
4   Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Plato Lee
4   Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Bernard R. Bendok
2   Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
John A. Kalapurakal
4   Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
James P. Chandler
2   Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
› Author Affiliations
Further Information

Publication History

02 October 2015

19 April 2016

Publication Date:
31 May 2016 (online)

Abstract

Objectives This study aims to report tumor control rates and cranial nerve function after low dose (11.0 Gy) Gamma knife radiosurgery (GKRS) in patients with vestibular schwannomas.

Methods A retrospective chart review was performed on 30 consecutive patients with vestibular schwannomas treated from March 2004 to August 2010 with GKRS at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. The marginal dose for all patients was 11.0 Gy prescribed to the 50% isodose line. Median follow-up time was 42 months. The median treatment volume was 0.53 cm3. Hearing data were obtained from audiometry reports before and after radiosurgery.

Results The actuarial progression free survival (PFS) based on freedom from surgery was 100% at 5 years. PFS based on freedom from persistent growth was 91% at 5 years. One patient experienced tumor progression requiring resection at 87 months. Serviceable hearing, defined as Gardner–Robertson score of I–II, was preserved in 50% of patients. On univariate and multivariate analyses, only higher mean and maximum dose to the cochlea significantly decreased the proportion of patients with serviceable hearing.

Conclusion Vestibular schwannomas can be treated with low doses (11.0 Gy) of GKRS with good tumor control and cranial nerve preservation.

Note

There was no funding received for this work. There are no financial, institutional, or personal interest disclosures to report.


 
  • References

  • 1 Karpinos M, Teh BS, Zeck O , et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 2002; 54 (5) 1410-1421
  • 2 Propp JM, McCarthy BJ, Davis FG, Preston-Martin S. Descriptive epidemiology of vestibular schwannomas. Neuro-oncol 2006; 8 (1) 1-11
  • 3 Conley GS, Hirsch BE. Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (5) 351-356
  • 4 Arthurs BJ, Lamoreaux WT, Mackay AR , et al. Gamma knife radiosurgery for vestibular schwannomas: tumor control and functional preservation in 70 patients. Am J Clin Oncol 2011; 34 (3) 265-269
  • 5 Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC. Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 1998; 339 (20) 1426-1433
  • 6 Shin YJ, Lapeyre-Mestre M, Gafsi I , et al. Neurotological complications after radiosurgery versus conservative management in acoustic neuromas: a systematic review-based study. Acta Otolaryngol 2003; 123 (1) 59-64
  • 7 Yang I, Aranda D, Han SJ , et al. Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: a systematic review. J Clin Neurosci 2009; 16 (6) 742-747
  • 8 Yang I, Sughrue ME, Han SJ , et al. A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma. J Neurosurg 2010; 112 (4) 851-859
  • 9 Combs SE, Welzel T, Kessel K , et al. Hearing preservation after radiotherapy for vestibular schwannomas is comparable to hearing deterioration in healthy adults and is accompanied by local tumor control and a highly preserved quality of life (QOL) as patients' self-reported outcome. Radiother Oncol 2013; 106 (2) 175-180
  • 10 Amichetti M, Amelio D, Minniti G. Radiosurgery with photons or protons for benign and malignant tumours of the skull base: a review. Radiat Oncol 2012; 7: 210
  • 11 Champ CE, Shen X, Shi W , et al. Reduced-dose fractionated stereotactic radiotherapy for acoustic neuromas: maintenance of tumor control with improved hearing preservation. Neurosurgery 2013; 73 (3) 489-496
  • 12 Baschnagel AM, Chen PY, Bojrab D , et al. Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 2013; 118 (3) 571-578
  • 13 Flickinger JC, Kondziolka D, Niranjan A, Maitz A, Voynov G, Lunsford LD. Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 2004; 60 (1) 225-230
  • 14 Hasegawa T, Kida Y, Kato T, Iizuka H, Kuramitsu S, Yamamoto T. Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 2013; 118 (3) 557-565
  • 15 Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2005; 102 (Suppl): 195-199
  • 16 Wolbers JG, Dallenga AH, Mendez Romero A, van Linge A. What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open 2013; 3 (2) e001345 DOI: 10.1136/bmjopen-2012-001345.
  • 17 Pollock BE, Link MJ, Foote RL. Failure rate of contemporary low-dose radiosurgical technique for vestibular schwannoma. J Neurosurg 2009; 111 (4) 840-844
  • 18 Foote KD, Friedman WA, Buatti JM, Meeks SL, Bova FJ, Kubilis PS. Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 2001; 95 (3) 440-449
  • 19 Miller RC, Foote RL, Coffey RJ , et al. Decrease in cranial nerve complications after radiosurgery for acoustic neuromas: a prospective study of dose and volume. Int J Radiat Oncol Biol Phys 1999; 43 (2) 305-311
  • 20 Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1988; 97 (1) 55-66
  • 21 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (2) 146-147
  • 22 Kaylie DM, Horgan MJ, Delashaw JB, McMenomey SO. A meta-analysis comparing outcomes of microsurgery and gamma knife radiosurgery. Laryngoscope 2000; 110 (11) 1850-1856
  • 23 Andrews DW, Werner-Wasik M, Den RB , et al. Toward dose optimization for fractionated stereotactic radiotherapy for acoustic neuromas: comparison of two dose cohorts. Int J Radiat Oncol Biol Phys 2009; 74 (2) 419-426
  • 24 Yang I, Sughrue ME, Han SJ , et al. Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery. J Neurooncol 2009; 93 (1) 41-48
  • 25 Iwai Y, Yamanaka K, Kubo T, Aiba T. Gamma knife radiosurgery for intracanalicular acoustic neuromas. J Clin Neurosci 2008; 15 (9) 993-997
  • 26 Roos DE, Potter AE, Zacest AC. Hearing preservation after low dose linac radiosurgery for acoustic neuroma depends on initial hearing and time. Radiother Oncol 2011; 101 (3) 420-424
  • 27 Paek SH, Chung HT, Jeong SS , et al. Hearing preservation after gamma knife stereotactic radiosurgery of vestibular schwannoma. Cancer 2005; 104 (3) 580-590
  • 28 Iwai Y, Yamanaka K, Shiotani M, Uyama T. Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 2003; 53 (2) 282-287 , discussion 287–288
  • 29 Régis J, Carron R, Delsanti C , et al. Radiosurgery for vestibular schwannomas. Neurosurg Clin N Am 2013; 24 (4) 521-530
  • 30 Petit JH, Hudes RS, Chen TT, Eisenberg HM, Simard JM, Chin LS. Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 2001; 49 (6) 1299-1306 , discussion 1306–1307
  • 31 Inoue HK. Low-dose radiosurgery for large vestibular schwannomas: long-term results of functional preservation. J Neurosurg 2005; 102 (Suppl): 111-113
  • 32 Régis J, Pellet W, Delsanti C , et al. Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 2002; 97 (5) 1091-1100
  • 33 Kim YH, Kim DG, Han JH , et al. Hearing outcomes after stereotactic radiosurgery for unilateral intracanalicular vestibular schwannomas: implication of transient volume expansion. Int J Radiat Oncol Biol Phys 2013; 85 (1) 61-67
  • 34 Nagano O, Higuchi Y, Serizawa T , et al. Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 2008; 109 (5) 811-816
  • 35 Tamura M, Carron R, Yomo S , et al. Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery 2009; 64 (2) 289-296 , discussion 296
  • 36 van Eck AT, Horstmann GA. Increased preservation of functional hearing after gamma knife surgery for vestibular schwannoma. J Neurosurg 2005; 102 (Suppl): 204-206
  • 37 Wowra B, Muacevic A, Jess-Hempen A, Hempel JM, Müller-Schunk S, Tonn JC. Outpatient gamma knife surgery for vestibular schwannoma: definition of the therapeutic profile based on a 10-year experience. J Neurosurg 2005; 102 (Suppl): 114-118
  • 38 Yamakami I, Uchino Y, Kobayashi E, Yamaura A. Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: a systematic review of outcome and risk of three therapeutic options. Neurol Res 2003; 25 (7) 682-690