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LINAC-based stereotactic radiosurgery versus hypofractionated stereotactic radiotherapy delivered in 3 or 5 fractions for vestibular schwannomas: comparative assessment from a single institution

Abstract

Purpose

The optimal treatment strategy for vestibular schwannoma (VS) is not known, and different radiation techniques and fractionation regimens are currently being used. This report aimed to assess outcomes after LINAC-based radiosurgery (SRS) and hypofractionated radiotherapy (hypo-FSRT) and identify possible differences in outcomes between hypo-FSRT delivered in 3 or 5 fractions.

Methods

From 2005 to 2017, 136 patients underwent treatment with radiotherapy for VS. Thirty-seven patients received SRS (12 Gy), and 99 received hypo-FSRT. Hypo-FSRT was delivered in 3 fractions (total 18–21 Gy, n = 39) and 5 fractions (total 25 Gy, n = 60).

Results

The median follow-up was 57 months. Eight patients had progression requiring surgery, corresponding to an overall local control rate of 93.4%, with no significant difference between the fractionation schedules. A correlation with borderline significance (p = 0.052) was detected between cystic tumors and local failure. A tendency toward a higher incidence of local failure was observed after 2015 when SRS treatment increased and included slightly larger tumors. Hearing preservation was observed in 35% of patients and 36% of patients experienced acute side effects, but persistent facial or trigeminal nerve toxicity was rare.

Conclusion

SRS and hypo-FSRT with 3 or 5 fractions provided a high rate of local control with no significant differences between treatment schedules. SRS is a well-documented radiation technique for VS and is the recommendation for small- to medium-sized tumors. This report demonstrates excellent long-term outcomes after hypo-FSRT; this regimen can be delivered safely and is an alternative for selected patients.

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Correspondence to Linn Söderlund Diaz.

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Söderlund Diaz, L., Hallqvist, A. LINAC-based stereotactic radiosurgery versus hypofractionated stereotactic radiotherapy delivered in 3 or 5 fractions for vestibular schwannomas: comparative assessment from a single institution. J Neurooncol (2020). https://doi.org/10.1007/s11060-020-03423-w

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Keywords

  • Vestibular schwannoma
  • Hypofractionated radiotherapy
  • Stereotactic radiosurgery
  • Hearing preservation
  • Facial nerve toxicity
  • Cystic tumor