Linear accelerator radiosurgery for vestibular schwannomas

William A. Friedman Department of Neurosurgery, University of Florida, Gainesville, Florida

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 M.D.
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Patrick Bradshaw Department of Neurosurgery, University of Florida, Gainesville, Florida

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Adam Myers Department of Neurosurgery, University of Florida, Gainesville, Florida

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Frank J. Bova Department of Neurosurgery, University of Florida, Gainesville, Florida

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Object

Radiosurgery has become a popular treatment for small vestibular schwannomas (VSs). The aim of this study was to review an extensive, single-institution experience with linear accelerator (LINAC) radiosurgery for VSs.

Methods

Between July 1988 and August 2005, 390 patients with VSs were treated with LINAC–based radiosurgery at the authors’ institution. Patient and treatment variables were prospectively maintained in a computer database. Outcomes were tracked through periodic clinical examinations and annual scanning studies. Multivariate and actuarial statistics were used to analyze rates of local tumor control and complications, including facial and trigeminal neuropathies, after treatment.

One- and 2-year actuarial control rates were both 98%, and the 5-year actuarial control rate was 90%. Only four patients (1%) required surgery for tumor growth. Seventeen patients (4.4%) reported facial weakness and 14 patients (3.6%) reported facial numbness after radiosurgery. The risk of these complications rose with increasing tumor volume or increasing radiosurgical dose to the tumor periphery. Since 1994, when doses were deliberately lowered to 1250 cGy, only two patients (0.7%) have experienced facial weakness and two (0.7%) have experienced facial numbness.

Conclusions

Radiosurgery provides a safe and effective therapeutic alternative to surgery for small VSs.

Abbreviations used in this paper:

CI = confidence interval; LINAC = linear accelerator; MR = magnetic resonance; OR = odds ratio; SRS = stereotactic radiosurgery; VS = vestibular schwannoma.
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  • 1

    Andrews DW, , Suarez O, , Goldman HW, , Downes MB, , Bednarz G, & Corn BW, et al.: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50:12651278, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Barcia Salorio JL, , Hernandez G, , Ciudad J, , Bordes V, & Broseta J: Stereotactic radiosurgery in acoustic neurinoma. Acta Neurochir Suppl 33:373376, 1984

  • 3

    Chang SD, , Gibbs IC, , Sakamoto GT, , Lee E, , Oyelese A, & Adler JR Jr: Staged stereotactic irradiation for acoustic neuroma. Neurosurgery 56:12541263, 2005

  • 4

    Delaney G, , Matheson J, & Smee R: Stereotactic radiosurgery: an alternative approach to the management of acoustic neuromas. Med J Aust 156:440, 1992

  • 5

    Flickinger JC, , Kondziolka D, , Niranjan A, & Lunsford LD: Results of acoustic neuroma radiosurgery: an analysis of 5 years’ experience using current methods. J Neurosurg 94:16, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Foote KD, , Friedman WA, , Buatti JM, , Bova FJ, & Meeks SL: Linear accelerator radiosurgery in brain tumor management. Neurosurg Clin N Am 10:203242, 1999

  • 7

    Foote KD, , Friedman WA, , Buatti JM, , Meeks SL, , Bova FJ, & Kubilis PS: Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 95:440449, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Friedman WA, , Buatti JM, , Bova FJ, & Mendenhall WM: LINAC Radiosurgery: A Practical Guide Berlin, Springer-Verlag, 1998

  • 9

    Fuss M, , Debus J, , Lohr F, , Huber P, , Rhein B, & Engenhart-Cabillic R, et al.: Conventionally fractionated stereotactic radiotherapy (FSRT) for acoustic neuromas. Int J Radiat Oncol Biol Phys 48:13811387, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Kondziolka D, , Nathoo N, , Flickinger JC, , Niranjan A, , Maitz A, & Lunsford LD: Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 53:815822, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Leksell L: A note on the treatment of acoustic tumors. Acta Chir Scand 137:763765, 1971

  • 12

    Lunsford LD, , Niranjan A, , Flickinger JC, , Maitz A, & Kondziolka D: Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 102:1 Suppl 195199, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Martens F, , Verbeke L, , Piessens M, & Van Vyve M: Stereotactic radiosurgery of vestibular schwannomas with a linear accelerator. Acta Neurochir Suppl 62:8892, 1994

  • 14

    Spiegelmann R, , Gofman J, , Alezra D, & Pfeffer R: Radiosurgery for acoustic neurinomas (vestibular schwannomas). Isr Med Assoc J 1:813, 1999

  • 15

    Spiegelmann R, , Lidar Z, , Gofman J, , Alezra D, , Hadani M, & Pfeffer R: Linear accelerator radiosurgery for vestibular schwannoma. J Neurosurg 94:713, 2001

  • 16

    Valentino V, & Raimondi AJ: Tumour response and morphological changes of acoustic neurinomas after radiosurgery. Acta Neurochir (Wien) 133:157163, 1995

  • 17

    Varlotto JM, , Shrieve DC, , Alexander E III, , Kooy HM, , Black PM, & Loeffler JS: Fractionated stereotactic radiotherapy for the treatment of acoustic neuromas: preliminary results. Int J Radiat Oncol Biol Phys 36:141145, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Williams JA: Fractionated stereotactic radiotherapy for acoustic neuromas: preservation of function versus size. J Clin Neurosci 10:4852, 2003

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