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Radiation Therapy in Acoustic Neuroma

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Radiation Oncology

Abstract

Neuromas or schwannomas of the eighth cranial nerve are benign slow-growing Schwann cell-derived tumors, called acoustic neuromas, or vestibular schwannomas. The incidence is approximately less than 1 per 100,000 persons/year. Acoustic neuroma has a clinical presentation related to cranial nerve involvement or brainstem and cerebellar compression due to tumor progression. When suspected, clinical diagnosed is confirmed by MRI. The management of vestibular schwannoma is still a quite controversial issue and can include wait and see policy, surgery, and radiotherapy. The treatment choice is based upon the balance between the expected morbidity of the tumor and of the therapy, taking into account also patient’s preference.

Medium size (2–3 cm) and large tumors (>3 cm) need an active treatment (surgery or radiotherapy), while smaller tumors can undergo observation as an alternative to active treatment.

Epidemiology, clinical presentation, diagnosis, and results of the current treatment options including observation, surgery, and radiotherapy will be presented and discussed.

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References

  • Anderson BM, Khuntia D, Bentzen SM, Geye HM, Hayes LL, Kuo JS, Baskaya MK, Badie B, Basavatia A, Pyle GM, Tomé WA, Mehta MP. Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery. J Neuro-Oncol. 2014;116(1):187–93.

    Article  Google Scholar 

  • Angeli S. Middle fossa approach: indications, technique, and results. Otolaryngol Clin N Am. 2012;45(2): 417–38.

    Article  Google Scholar 

  • Antonio Mazzoni, Elisabetta Zanoletti, Luca Denaro, Alessandro Martini, Domenico d’ Avella, (2017) Retrolabyrinthine Meatotomy as Part of Retrosigmoid Approach to Expose the Whole Internal Auditory Canal: Rationale, Technique and Outcome in Hearing Preservation Surgery for Vestibular Schwannoma. Operative Neurosurgery.

    Google Scholar 

  • Apicella G, Paolini M, Deantonio L, Masini L, Krengli M. Radiotherapy for vestibular schwannoma: review of recent literature results. Rep Pract Oncol Radiother. 2016;21(4):399–406.

    Article  PubMed  PubMed Central  Google Scholar 

  • Boari N, Bailo M, Gagliardi F, Franzin A, Gemma M, del Vecchio A, Bolognesi A, Picozzi P, Mortini P. Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg. 2014;121(Suppl):123–42.

    PubMed  Google Scholar 

  • Bortkiewicz A, Gadzicka E, Szymczak W. Mobile phone use and risk for intracranial tumors and salivary gland tumors –a meta-analysis. Int J Occup Med Environ Health. 2017;30(1):27–43.

    PubMed  Google Scholar 

  • Brackmann DE, House JR 3rd, Hitselberger WE. Technical modifications to the middle fossa craniotomy approach in removal of acoustic neuromas. Am J Otol. 1994;15(5):614–9.

    CAS  PubMed  Google Scholar 

  • Breivik CN, Nilsen RM, Myrseth E, Pedersen PH, Varughese JK, Chaudhry AA, Lund-Johansen M. Conservative management or Gamma Knife radiosurgery for vestibular schwannoma: tumor growth symptoms, and quality of life. Neurosurgery. 2013;73(1):48–56.

    Article  PubMed  Google Scholar 

  • Carlson ML, Jacob JT, Pollock BE, Neff BA, Tombers NM, Driscoll CL, Link MJ. Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline. J Neurosurg. 2013;118(3):579–87.

    Article  PubMed  Google Scholar 

  • Caruso JP, Moosa S, Fezeu F, Ramesh A, Sheehan JP A cost comparative study of Gamma Knife radiosurgery versus open surgery for intracranial pathology. J Clin Neurosci. 2015;22(1):184–8.

    Article  PubMed  Google Scholar 

  • Champ C, Shen X, Shi W, Mayekar SU, Chapman K, Werner-Wasik M, Farrell CJ, Gunn V, Downes MB, Liu H, Evans JJ, Andrews DW. Reduced-dose fractionated stereotactic radiotherapy for acoustic neuromas: maintenance of tumor control with improved hearing preservation. Neurosurgery. 2013;73(3):489–96.

    Article  PubMed  Google Scholar 

  • Chen M, Fan Z, Zheng X, Cao F, Wang L. Risk factors of acoustic neuroma: systematic review and meta-analysis. Yonsei Med J. 2016;57(3):776–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Collen C, Ampe B, Gevaert T, Moens M, Linthout N, De Ridder M, Verellen D, D'Haens J, Storme G. Single fraction versus fractionated linac-based stereotactic radiotherapy for vestibular schwannoma: a single-institution experience. Int J Radiat Oncol Biol Phys. 2011;81(4):e503–9.

    Article  PubMed  Google Scholar 

  • Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL. Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas –pooled results from 3 large German centers. Radiother Oncol. 2015;114(3):378–83.

    Article  PubMed  Google Scholar 

  • Committee on Hearing and Equilibrium. Committee on Hearing and Equilibrium guidelines for evaluation of hearing preservation in acoustic Neuroma. Otolaryngol Head Neck Surg. 1995;113(3):179–80.

    Article  Google Scholar 

  • Falcioni M, Fois P, Taibah A, Sanna M. Facial nerve function after vestibular schwannoma surgery. J Neurosurg. 2011;115(4):820–6.

    Article  PubMed  Google Scholar 

  • Fabien Litre, Pascal Rousseaux, Nicolas Jovenin, Arnaud Bazin, Philippe Peruzzi, Didier Wdowczyk, Philippe Colin, (2013) Fractionated stereotactic radiotherapy for acoustic neuromas: A prospective monocenter study of about 158 cases. Radiotherapy and Oncology. 106 (2):169–174.

    Google Scholar 

  • Fossati P, Vavassori A, Deantonio L, Ferrara E, Krengli M, Orecchia R. Review of photon and proton radiotherapy for skull base tumours. Rep Pract Oncol Radiother. 2016;21(4):336–55.

    Article  PubMed  PubMed Central  Google Scholar 

  • Friedman RA, Goddard JC, Wilkinson EP, Schwartz MS, Slattery WH 3rd, Fayad JN, Brackmann DE. Hearing preservation with the middle cranial fossa approach for neurofibromatosis type 2. Otol Neurotol. 2011;32(9):1530–7.

    Article  PubMed  Google Scholar 

  • Frisch CD, Eckel LJ, Lane JI, Neff BA. Intralabyrinthine schwannomas. Otolaryngol Clin N Am. 2015;48(3): 423–41.

    Article  Google Scholar 

  • Gait C, Frew EJ, Martin TPC, Jowett S, Irving R. Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model-based approach to cost-effectiveness. Clin Otolaryngol. 2014;39(1):22–31.

    Article  CAS  PubMed  Google Scholar 

  • Hansasuta A, Choi CYH, Gibbs IC, Soltys SG, Tse VC, Lieberson RE, Hayden MG, Sakamoto GT, Harsh GR 4th, Adler JR Jr, Chang SD. Multisession stereotactic radiosurgery for vestibular schwannomas: single-institution experience with 383 cases. Neurosurgery. 2011;69(6):1200–9.

    Article  PubMed  Google Scholar 

  • 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): 557–65.

    Article  PubMed  Google Scholar 

  • Kessel KA, Fischer H, Vogel MME, Oechsner M, Bier H, Meyer B, Combs SE. Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma. Hearing preservation and patients’ self-reported outcome based on an established questionnaire. Strahlenther Onkol. 2017;193(3):192–9.

    Article  PubMed  Google Scholar 

  • Kim YH, Kim DG, Han JH, Chung HT, Kim IK, Song SW, Park JH, Kim JW, Kim YH, Park CK, Kim CY, Paek SH, Jung HW. Hearing outcomes after stereotactic radiosurgery for unilateral intracanalicular vestibular schwannomas: implication of transient volume expansion. Int J Radiat Oncol Biol Phys. 2013;85(1):61–7.

    Article  PubMed  Google Scholar 

  • Kirchmann M, Karnov K, Hansen S, Dethloff T, Stangerup SE, Caye-Thomasen P. Ten-year follow-up on tumor growth and hearing in patients observed with an intracanalicular vestibular schwannoma. Neurosurgery. 2017;80(1):49–56.

    PubMed  Google Scholar 

  • Kopp C, Fauser C, Müller A, Astner ST, Jacob V, Lumenta C, Meyer B, Tonn JC, Molls M, Grosu AL. Stereotactic fractionated radiotherapy and linac radiosurgery in the treatment of vestibular schwannoma – report about both stereotactic methods from a single institution. Int J Radiat Oncol Biol Phys. 2011;80(5): 1485–91.

    Article  PubMed  Google Scholar 

  • Krengli M, Apicella G, Deantonio L, Paolini M, Masini L. Stereotactic radiation therapy for skull base recurrences: is a salvage approach still possible? Rep Pract Oncol Radiother. 2015;20(6):430–9.

    Article  PubMed  Google Scholar 

  • Lin D, Hegarty JL, Fischbein NJ, Jackler RK. The prevalence of “incidental” acoustic neuroma. Arch Otolaryngol Head Neck Surg. 2005;131(3):241–4.

    Article  PubMed  Google Scholar 

  • Maniakas A, Saliba I. Microsurgery versus 574 stereotactic radiation for small vestibular schwannomas: a 575 meta-analysis of patients with more than 5 years follow-up. Otol Neurotol. 2012;33(9):1611–20.

    Article  PubMed  Google Scholar 

  • Marks LB, Yorke D, Jackson, AY, Ten Haken AR, Constine LS, Eisbruch XA, Bentzen SM, Nam KJ, Deasy JO. Use Of Normal Tissue Complication Probability Models In The Clinic. J Radiation Oncology Biol Phys 2010;76(3):S10-S19. 

    Google Scholar 

  • Martini A, Marioni G, Zanoletti E, Cappellesso R, Stramare R, Fasanaro E, Faccioli C, Giacomelli L, Denaro L, D’Avella D, Mazzoni A, Fassina A. YAP, TAZ and AREG expression in eighth cranial nerve schwannoma. Int J Biol Markers. 2017;32(3):319–24.

    Article  Google Scholar 

  • Mazzoni A, Biroli F, Foresti C, Signorelli A, Sortino C, Zanoletti E. Hearing preservation surgery in acoustic neuroma. Slow progress and new strategies. Acta Otorhinolaryngol Ital. 2011;31(2):76–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Morrison D. Management of patients with acoustic neuromas: a Markov decision analysis. Laryngoscope. 2010;120(4):783–90.

    Article  PubMed  Google Scholar 

  • Muzevic D, Legcevic J, Splavski B, Caye-Thomasen P. Stereotactic radiotherapy for vestibular schwannoma. Cochrane Database Syst Rev. 2014;16(12):CD009897.

    Google Scholar 

  • Myrseth E, Moller P, Pedersen PH, Lund-Johansen M. Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery. 2009;64(4):654–61.

    Article  PubMed  Google Scholar 

  • Ouerdani A, Goutagny S, Kalamarides M, Trocóniz IF, Ribba B. Mechanism-based modeling of the clinical effects of bevacizumab and everolimus on vestibular schwannomas of patients with neurofibromatosis type 2. Cancer Chemother Pharmacol. 2016;77(6):1263–73.

    Article  CAS  PubMed  Google Scholar 

  • Persson O, Bartek JJ, Shalom NB, Wangerid T, Jakola AS, Förander P. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. Acta Neurochir. 2017;159(6):1013–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Plotkin SR, Stemmer-Rachamimov AO, Barker FG 2nd, Halpin C, Padera TP, Tyrrell A, Sorensen AG, Jain RK, di Tomaso E. Hearing improvement after bevacizumab in patients with neurofibromatosis type 2. N Engl J Med. 2009;361(4):358–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Puataweepong P, Dhanachai M, Dangprasert S, Narkwong L, Sitathanee C, Sawangsilpa T, Janwityanujit T, Yongvithisatid P. Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas: comparative observations of 139 patients treated at a single institution. J Radiat Res. 2014;55(2):351–8.

    Article  PubMed  Google Scholar 

  • Régis J, Delsanti C, Roche PH. Editorial: vestibular schwannoma radiosurgery: progression or pseudoprogression? J Neurosurg. 2017;127(2):374–9.

    Article  PubMed  Google Scholar 

  • Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannomasurgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg. 2006;105(4): 527–35.

    Article  PubMed  Google Scholar 

  • Schneider AB, Ron E, Lubin J, Stovall M, Shore-Freedman E, Tolentino J, Collins BJ. Acoustic neuromas following childhood radiation treatment for benign conditions of the head and neck. Neuro-Oncol. 2008;10(1):73–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schulz A, Büttner R, Hagel C, Baader SL, Kluwe L, Salamon J, Mautner VF, Mindos T, Parkinson DB, Gehlhausen JR, Clapp DW, Morrison H. The importance of nerve microenvironment for schwannoma development. Acta Neuropathol. 2016;132(2): 289–307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Smouha EE, Yoo M, Mohr K, Davis RP. Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope. 2005;115(3):450–4.

    Article  PubMed  Google Scholar 

  • Sriskandan N, Conner SEJ. The role of radiology in the diagnosis and management of vestibular schwannoma. Clin Radiol. 2011;66(4):357–65.

    Article  CAS  PubMed  Google Scholar 

  • Stangerup R, Tos M, Thomsen J, Caye-Thomasen P. True incidence of vestibular schwannoma? Neurosurgery. 2010;67(5):1335–40.

    Article  PubMed  Google Scholar 

  • Sughrue ME, Yang I, Aranda D, Lobo K, Pitts LH, Cheung SW, Parsa AT. The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. J Neurosurg. 2010;112(1):163–7.

    Article  PubMed  Google Scholar 

  • Vernimmen FJ, Slabbert JP. Assessment of the alpha/beta ratios for arteriovenous malformations, meningiomas, acoustic neuromas, and the optic chiasma. Int J Radiat Biol. 2010;86(6):486–98.

    Article  CAS  PubMed  Google Scholar 

  • Vernimmen FJ, Mohamed Z, Slabbert JP, Wilson J. Long-term results of stereotactic proton beam radiotherapy for acoustic neuromas. Radiother Oncol. 2009;90(2): 208–12.

    Article  PubMed  Google Scholar 

  • Zanoletti E, Faccioli C, Martini A. Surgical treatment of acoustic neuroma: outcomes and indications. Rep Pract Oncol Radiother. 2016;21(4):395–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Radiotherapy Division, University Hospital “Maggiore della Carità”, Novara, Italy

    Marco Krengli & Letizia Deantonio

  2. Department of Translational Medicine, University of “Piemonte Orientale”, Novara, Italy

    Marco Krengli & Letizia Deantonio

  3. Otolaryngology, Neurosciences Department, University Hospital of Padova, Padova, Italy

    Elisabetta Zanoletti

Authors
  1. Marco Krengli
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  2. Elisabetta Zanoletti
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  3. Letizia Deantonio
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Corresponding author

Correspondence to Marco Krengli .

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Editors and Affiliations

  1. Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany

    Frederik Wenz

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Krengli, M., Zanoletti, E., Deantonio, L. (2018). Radiation Therapy in Acoustic Neuroma. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_11-1

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  • DOI: https://doi.org/10.1007/978-3-319-52619-5_11-1

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  • Print ISBN: 978-3-319-52619-5

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