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.
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).
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.
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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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
- Vestibular schwannoma
- Hypofractionated radiotherapy
- Stereotactic radiosurgery
- Hearing preservation
- Facial nerve toxicity
- Cystic tumor