Abstract
Neuromas are benign intracranial tumors with indolent natural history. Surgery is the mainstay of treatment and only after the introduction of single-fraction stereotactic radiosurgery (SRS), radiotherapy emerged as an alternative viable option. In this review, we focused on SRS or conventionally fractionated stereotactic radiotherapeutic (FSRT) approaches. We described the results of different doses used for SRS and FSRT, the current status, and a comparison between the two radiotherapy approaches. Stereotactic radiotherapy techniques aim to control tumor growth with minimal toxicity. SRS using either a cobalt unit or a linear accelerator has given high rates of tumor control and of cranial nerve function preservation with marginal doses range of 12–14 Gy. Fractionated stereotactic radiotherapy (FSRT) is optimal for tumors larger than 3 cm. Doses as low as 50.4 Gy provide excellent control rates and low morbidity. Overall, both SRS and FSRT are equally effective and safe options for neuroma patients who do not need immediate surgical decompression.
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References
Propp JM, McCarthy BJ, Davis FG, Preston-Martin S (2006) Descriptive epidemiology of vestibular schwannomas. Neuro-oncology 8:1–11. https://doi.org/10.1215/S1522851704001097
Schmidt RF, Boghani Z, Choudhry OJ, Eloy JA, Jyung RW, Liu JK (2012) Incidental vestibular schwannomas: a review of prevalence, growth rate, and management challenges. Neurosurg Focus 33:E4. https://doi.org/10.3171/2012.7.FOCUS12186
Foley RW, Shirazi S, Maweni RM, Walsh K, McConn Walsh R, Javadpour M, Rawluk D (2017) Signs and symptoms of acoustic neuroma at initial presentation: an exploratory analysis. Cureus 9:e1846. https://doi.org/10.7759/cureus.1846
Mulkens TH, Parizel PM, Martin JJ, Degryse HR, van de Heyning PH, Forton GE, de Schepper AM (1993) Acoustic schwannoma: MR findings in 84 tumors. AJR Am J Roentgenol 160:395–398. https://doi.org/10.2214/ajr.160.2.8424360
Tali ET, Yuh WT, Nguyen HD, Feng G, Koci TM, Jinkins JR, Robinson RA, Hasso AN (1993) Cystic acoustic schwannomas: MR characteristics. AJNR Am J Neuroradiol 14:1241–1247
Carlson ML, Link MJ, Wanna GB, Driscoll CLW (2015) Management of sporadic vestibular schwannoma. Otolaryngol Clin N Am 48:407–422. https://doi.org/10.1016/j.otc.2015.02.003
Tsao MN, Sahgal A, Xu W, de Salles A, Hayashi M, Levivier M, Ma L, Martinez R, Régis J, Ryu S, Slotman BJ, Paddick I (2017) Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline. J Radiosurg SBRT 5:5–24
Kirchmann M, Karnov K, Hansen S, Dethloff T, Stangerup SE, Caye-Thomasen P (2017) Ten-year follow-up on tumor growth and hearing in patients observed with an intracanalicular vestibular schwannoma. Neurosurgery 80:49–56. https://doi.org/10.1227/NEU.0000000000001414
Patnaik U, Prasad SC, Tutar H, Giannuzzi AL, Russo A, Sanna M (2015) The long-term outcomes of wait-and-scan and the role of radiotherapy in the management of vestibular schwannomas. Otol Neurotol 36:638–646. https://doi.org/10.1097/MAO.0000000000000657
Babu R, Sharma R, Bagley JH, Hatef J, Friedman AH, Adamson C (2013) Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. J Neurosurg 119:121–130. https://doi.org/10.3171/2013.1.JNS121370
Leksell L (1971) A note on the treatment of acoustic tumours. Acta Chir Scand 137:763–765
Maniakas A, Saliba I (2012) Microsurgery versus stereotactic radiation for small vestibular schwannomas: a meta-analysis of patients with more than 5 years’ follow-up. Otol Neurotol 33:1611–1620. https://doi.org/10.1097/MAO.0b013e31826dbd02
Norén G, Arndt J, Hindmarsh T, Hirsch A (1988) Stereotactic radiosurgical treatment of acoustic neurinomas. In: Modern stereotactic neurosurgery. Springer US, Boston, pp 481–489
Flickinger JC, Lunsford LD, Linskey ME et al (1993) Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results. Radiother Oncol 27:91–98
Mendenhall WM, Friedman WA, Buatti JM, Bova FJ (1996) Preliminary results of linear accelerator radiosurgery for acoustic schwannomas. J Neurosurg 85:1013–1019. https://doi.org/10.3171/jns.1996.85.6.1013
Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433. https://doi.org/10.1056/NEJM199811123392003
Foote RL, Coffey RJ, Swanson JW, Harner SG, Beatty CW, Kline RW, Stevens LN, Hu TC (1995) Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 32:1153–1160
Suh JH, Barnett GH, Sohn JW, Kupelian PA, Cohen BH (2000) Results of linear accelerator-based stereotactic radiosurgery for recurrent and newly diagnosed acoustic neuromas. Int J Cancer 90:145–151
Chopra R, Kondziolka D, Niranjan A, Lunsford LD, Flickinger JC (2007) Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 68:845–851. https://doi.org/10.1016/j.ijrobp.2007.01.001
Myrseth E, Møller P, Pedersen P-H et al (2005) Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery 56:927–935 discussion 927–35
Murphy ES, Barnett GH, Vogelbaum MA, Neyman G, Stevens GHJ, Cohen BH, Elson P, Vassil AD, Suh JH (2011) Long-term outcomes of Gamma Knife radiosurgery in patients with vestibular schwannomas. J Neurosurg 114:432–440. https://doi.org/10.3171/2009.12.JNS091339
Friedman WA, Bradshaw P, Myers A, Bova FJ (2006) Linear accelerator radiosurgery for vestibular schwannomas. J Neurosurg 105:657–661. https://doi.org/10.3171/jns.2006.105.5.657
Iwai Y, Yamanaka K, Kubo T, Aiba T (2008) Gamma knife radiosurgery for intracanalicular acoustic neuromas. J Clin Neurosci 15:993–997. https://doi.org/10.1016/j.jocn.2007.09.008
Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D (1999) Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753–762 discussion 762–5
Okunaga T, Matsuo T, Hayashi N, Hayashi Y, Shabani HK, Kaminogo M, Ochi M, Nagata I (2005) Linear accelerator radiosurgery for vestibular schwannoma: measuring tumor volume changes on serial three-dimensional spoiled gradient-echo magnetic resonance images. J Neurosurg 103:53–58. https://doi.org/10.3171/jns.2005.103.1.0053
Hasegawa T, Kida Y, Kato T, Iizuka H, Kuramitsu S, Yamamoto T (2013) 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 118:557–565. https://doi.org/10.3171/2012.10.JNS12523
Breivik CN, Nilsen RM, Myrseth E, Pedersen PH, Varughese JK, Chaudhry AA, Lund-Johansen M (2013) Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life. Neurosurgery 73:48–56– discussion 56–7. https://doi.org/10.1227/01.neu.0000429862.50018.b9
Kalogeridi M-A, Georgolopoulou P, Kouloulias V, Kouvaris J, Pissakas G (2009) Long-term results of LINAC-based stereotactic radiosurgery for acoustic neuroma: the Greek experience. J Cancer Res Ther 5:8–13
Combs SE, Volk S, Schulz-Ertner D, Huber PE, Thilmann C, Debus J (2005) Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): long-term results in 106 patients treated in a single institution. Int J Radiat Oncol Biol Phys 63:75–81. https://doi.org/10.1016/j.ijrobp.2005.01.055
Chan AW, Black P, Ojemann RG et al (2005) Stereotactic radiotherapy for vestibular schwannomas: favorable outcome with minimal toxicity. Neurosurgery 57:60–70 discussion 60–70
Selch MT, Pedroso A, Lee SP, Solberg TD, Agazaryan N, Cabatan-Awang C, Desalles AAF (2004) Stereotactic radiotherapy for the treatment of acoustic neuromas. J Neurosurg 101(Suppl 3):362–372. https://doi.org/10.3171/jns.2004.101.supplement
Woolf DK, Williams M, Goh CL, Henderson DR, Menashy RV, Simpson N, Mastroianni B, Collis CH (2013) Fractionated stereotactic radiotherapy for acoustic neuromas: long-term outcomes. Clin Oncol (R Coll Radiol) 25:734–738. https://doi.org/10.1016/j.clon.2013.08.002
Litre F, Rousseaux P, Jovenin N, Bazin A, Peruzzi P, Wdowczyk D, Colin P (2013) Fractionated stereotactic radiotherapy for acoustic neuromas: a prospective monocenter study of about 158 cases. Radiother Oncol 106:169–174. https://doi.org/10.1016/j.radonc.2012.10.013
Koh E-S, Millar B-A, Ménard C, Michaels H, Heydarian M, Ladak S, McKinnon S, Rutka JA, Guha A, Pond GR, Laperriere NJ (2007) Fractionated stereotactic radiotherapy for acoustic neuroma: single-institution experience at The Princess Margaret Hospital. Cancer 109:1203–1210. https://doi.org/10.1002/cncr.22499
Champ CE, Shen X, Shi W, Mayekar SU, Chapman K, Werner-Wasik M, Farrell CJ, Gunn V, Downes MB, Liu H, Evans JJ, Andrews DW (2013) Reduced-dose fractionated stereotactic radiotherapy for acoustic neuromas: maintenance of tumor control with improved hearing preservation. Neurosurgery 73:489–496. https://doi.org/10.1227/NEU.0000000000000019
Hansasuta A, Choi CYH, Gibbs IC, Soltys SG, Tse VCK, Lieberson RE, Hayden MG, Sakamoto GT, Harsh GR IV, Adler JR Jr, Chang SD (2011) Multisession stereotactic radiosurgery for vestibular schwannomas: single-institution experience with 383 cases. Neurosurgery 69:1200–1209. https://doi.org/10.1227/NEU.0b013e318222e451
Tsai J-T, Lin J-W, Lin C-M, Chen YH, Ma HI, Jen YM, Chen YH, Ju DT (2013) Clinical evaluation of CyberKnife in the treatment of vestibular schwannomas. Biomed Res Int 2013:297093–297096. https://doi.org/10.1155/2013/297093
Meijer OWM, Vandertop WP, Baayen JC, Slotman BJ (2003) Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys 56:1390–1396
Anderson BM, Khuntia D, Bentzen SM, Geye HM, Hayes LL, Kuo JS, Baskaya MK, Badie B, Basavatia A, Pyle GM, Tomé WA, Mehta MP (2014) Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery. J Neuro-Oncol 116:187–193. https://doi.org/10.1007/s11060-013-1282-4
Patel MA, Marciscano AE, Hu C, Jusué-Torres I, Garg R, Rashid A, Francis HW, Lim M, Redmond KJ, Rigamonti D, Kleinberg LR (2017) Long-term treatment response and patient outcomes for vestibular schwannoma patients treated with hypofractionated stereotactic radiotherapy. Front Oncol 7:–200. https://doi.org/10.3389/fonc.2017.00200
Weber DC, Chan AW, Bussiere MR, Harsh GR IV, Ancukiewicz M, Barker FG II, Thornton AT, Martuza RL, Nadol JB Jr, Chapman PH, Loeffler JS (2003) Proton beam radiosurgery for vestibular schwannoma: tumor control and cranial nerve toxicity. Neurosurgery 53:577–586 discussion 586–8
Vernimmen FJAI, Mohamed Z, Slabbert JP, Wilson J (2009) Long-term results of stereotactic proton beam radiotherapy for acoustic neuromas. Radiother Oncol 90:208–212. https://doi.org/10.1016/j.radonc.2008.11.004
Nguyen T, Duong C, Sheppard JP, Lee SJ, Kishan AU, Lee P, Tenn S, Chin R, Kaprealian TB, Yang I (2018) Hypo-fractionated stereotactic radiotherapy of five fractions with linear accelerator for vestibular schwannomas: a systematic review and meta-analysis. Clin Neurol Neurosurg 166:116–123. https://doi.org/10.1016/j.clineuro.2018.01.005
Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL (2015) 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 114:378–383. https://doi.org/10.1016/j.radonc.2015.01.011
Collen C, Ampe B, Gevaert T, Moens M, Linthout N, de Ridder M, Verellen D, D’Haens J, Storme G (2011) Single fraction versus fractionated linac-based stereotactic radiotherapy for vestibular schwannoma: a single-institution experience. Int J Radiat Oncol Biol Phys 81:e503–e509. https://doi.org/10.1016/j.ijrobp.2011.04.066
Kopp C, Fauser C, Müller A, Astner ST, Jacob V, Lumenta C, Meyer B, Tonn JC, Molls M, Grosu AL (2011) 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 80:1485–1491. https://doi.org/10.1016/j.ijrobp.2010.04.057
Puataweepong P, Dhanachai M, Dangprasert S, Narkwong L, Sitathanee C, Sawangsilpa T, Janwityanujit T, Yongvithisatid P (2014) Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas: comparative observations of 139 patients treated at a single institution. J Radiat Res 55:351–358. https://doi.org/10.1093/jrr/rrt121
Møller MN, Hansen S, Miyazaki H, Stangerup SE, Caye-Thomasen P (2014) Active treatment is not indicated in the majority of patients diagnosed with a vestibular schwannoma: a review on the natural history of hearing and tumor growth. Curr Otorhinolaryngol Rep 2:242–247. https://doi.org/10.1007/s40136-014-0064-7
Smouha EE, Yoo M, Mohr K, Davis RP (2005) Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm. Laryngoscope 115:450–454. https://doi.org/10.1097/01.mlg.0000175681.52517.cf
Whitmore RG, Urban C, Church E, Ruckenstein M, Stein SC, Lee JYK (2011) Decision analysis of treatment options for vestibular schwannoma. J Neurosurg 114:400–413. https://doi.org/10.3171/2010.3.JNS091802
Moriyama T, Fukushima T, Asaoka K, Roche PH, Barrs DM, McElveen JT (2002) Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor. J Neurosurg 97:337–340. https://doi.org/10.3171/jns.2002.97.2.0337
Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–21 discussion 21–3
Pollock BE, Driscoll CLW, Foote RL, Link MJ, Gorman DA, Bauch CD, Mandrekar JN, Krecke KN, Johnson CH (2006) Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 59:77–85– discussion 77–85. https://doi.org/10.1227/01.NEU.0000219217.14930.14
Karpinos M, Teh BS, Zeck O, Carpenter LS, Phan C, Mai WY, Lu HH, Chiu JK, Butler EB, Gormley WB, Woo SY (2002) Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54:1410–1421
Golfinos JG, Hill TC, Rokosh R, Choudhry O, Shinseki M, Mansouri A, Friedmann DR, Thomas Roland J, Kondziolka D (2016) A matched cohort comparison of clinical outcomes following microsurgical resection or stereotactic radiosurgery for patients with small- and medium-sized vestibular schwannomas. J Neurosurg 125:1472–1482. https://doi.org/10.3171/2015.12.JNS151857
Wolbers JG, Dallenga AH, Mendez Romero A, van Linge A (2013) What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open 3:e001345. https://doi.org/10.1136/bmjopen-2012-001345
Di Maio S, Akagami R (2009) Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas. J Neurosurg 111:855–862. https://doi.org/10.3171/2008.10.JNS081014
Carlson ML, Tveiten OV, Driscoll CL, Goplen FK, Neff BA, Pollock BE, Tombers NM, Castner ML, Finnkirk MK, Myrseth E, Pedersen PH, Lund-Johansen M, Link MJ (2015) Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg 122:833–842. https://doi.org/10.3171/2014.11.JNS14594
McClelland S, Gerbi BJ, Cho KH, Hall WA (2007) The treatment of a large acoustic tumor with fractionated stereotactic radiotherapy. J Robot Surg 1:227–230. https://doi.org/10.1007/s11701-007-0036-8
Mandl ES, Meijer OWM, Slotman BJ, Vandertop WP, Peerdeman SM (2010) Stereotactic radiation therapy for large vestibular schwannomas. Radiother Oncol 95:94–98. https://doi.org/10.1016/j.radonc.2009.12.042
Hasegawa T, Kida Y, Yoshimoto M, Koike J, Goto K (2006) Evaluation of tumor expansion after stereotactic radiosurgery in patients harboring vestibular schwannomas. Neurosurgery 58:1119–1128– discussion 1119–28. https://doi.org/10.1227/01.NEU.0000215947.35646.DD
Nagano O, Higuchi Y, Serizawa T, Ono J, Matsuda S, Yamakami I, Saeki N (2008) Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg 109:811–816. https://doi.org/10.3171/JNS/2008/109/11/0811
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Kalogeridi, MA., Kougioumtzopoulou, A., Zygogianni, A. et al. Stereotactic radiosurgery and radiotherapy for acoustic neuromas. Neurosurg Rev 43, 941–949 (2020). https://doi.org/10.1007/s10143-019-01103-6
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DOI: https://doi.org/10.1007/s10143-019-01103-6