Ten-Year Retreatment Rates for 416 Vestibular Schwannoma Patients Primarily Undergoing Surgery, Observation, or Radiosurgery

Aim: Long-term follow-up studies of treated and untreated vestibular schwannoma patients are scarce. Data about treatment efficacy is needed to establish sustainable follow-up routines.

Methods: We calculated retreatment rates of patients followed up for 10 to 20 years after management by an algorithm based on tumor size and growth, using Kaplan–Meier statistics.

Results: We treated 431 cases at our national center from 2000 to 2010. (Mean age 56.6 (12.6 SD) years, 83 by surgery, 115 by radiosurgery, 218 by observation). Key outcomes: 16 of 431 patients failed follow-up leading to a 97% follow-up rate. Follow-up time: 8.4 (mean) and 10.0 (median) years, range: 1–17.1 years. At database review (January 31, 2022), 361 patients were alive. Mean age at death for the 70 deceased was 77.3 years; for those alive: 69.5 years. Altogether 220 out of 361 living patients had a follow-up time of 10 years or more. In the following, primary observation is categorized as a “first treatment,” similar to radiosurgery and microsurgery. The 5-year second treatment rates were: surgery: 11/83 = 13.3%; radiosurgery: 11/115 = 9.6%; observation: 82/218 = 37.6%. The 5- to 10-year second treatment rates (including only cases “at risk”) were surgery: 2/77 = 2.6%; radiosurgery: 4/72 = 5.6%; observation: 24/124 = 19.0%. Analyzing patients who had undergone one second treatment, 3/13 initially operated, 3/15 initially irradiated, and 9/106 patients undergoing primary observation underwent a third treatment.

Conclusion: There was no significant difference between microsurgery and radiosurgery retreatment rates at 5 and 10 years. After 5 years, the retreatment rates dropped to very low levels for both. Patients undergoing observation need regular follow-up for at least 10 years, as nearly 20% of cases at risk underwent treatment after more than 5 years. Further details will be given at presentation.

Publication History

Article published online:
01 February 2023