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Longitudinal Radiographic Outcomes of Vestibular Schwannoma in Single and Fractionated Stereotactic Radiosurgery: A Retrospective Cohort Study.
- Source :
-
Journal of neurological surgery. Part B, Skull base [J Neurol Surg B Skull Base] 2020 Jun; Vol. 81 (3), pp. 308-316. Date of Electronic Publication: 2019 Jun 12. - Publication Year :
- 2020
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Abstract
- Management of vestibular schwannoma (VS) includes stereotactic radiosurgery (SRS) in single or fractionated treatments. There is a paucity of literature on the three-dimensional (3D) volumetric kinetics and radiological changes following SRS and no consensus on appropriate post-SRS surveillance imaging timeline. This is a retrospective cohort study with institutional review board approval. A total of 55 patients met study criteria. We collected volumetric kinetic data in VS treated with SRS over time using a target volume contouring software. We also tracked radiographic phenomena such as pseudoprogression and necrosis. A secondary objective was to describe our overall treatment success rate and any failures. For all treatments groups, pseudoprogression most typically occurred within 12 months post-SRS, after which tumor volumes on average normalized and then decreased from pretreatment size at the last follow-up. Only two patients required salvage therapy post-SRS and were considered SRS treatment failures. Both patients were in the five-fraction cohort but with a lower biologically equivalent dose. Our study is first to collect 3D volumetric kinetics of VS following single and fractionated SRS in contrast to extrapolations from single and two-dimensional measurements. Our longitudinal data also show initial increases in volume in the first 12 months post-SRS followed by later declines, setting up interesting questions regarding the utility of early posttreatment surveillance imaging in the asymptomatic patient. Finally, we show low rates of treatment failure (3.6%) and show in our cohort that SRS dose de-escalation posed a risk of treatment failure.<br />Competing Interests: Conflict of Interest None.<br /> (© Thieme Medical Publishers.)
Details
- Language :
- English
- ISSN :
- 2193-6331
- Volume :
- 81
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of neurological surgery. Part B, Skull base
- Publication Type :
- Academic Journal
- Accession number :
- 32500007
- Full Text :
- https://doi.org/10.1055/s-0039-1692642