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. 2017;5(1):5-24.

Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline

May N Tsao  1 , Arjun Sahgal  1 , Wei Xu  2 , Antonio De Salles  3 , Motohiro Hayashi  4 , Marc Levivier  5 , Lijun Ma  6 , Roberto Martinez  7 , Jean Régis  8 , Sam Ryu  9 , Ben J Slotman  10 , Ian Paddick  11
Affiliations

Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline

May N Tsao et al. J Radiosurg SBRT. 2017.

Abstract

Objectives: The aim of this systematic review was to develop International Stereotactic Radiosurgery Society (ISRS) consensus guideline statements for vestibular schwannoma.

Methods: A systematic review of the literature was performed up to April 2015.

Results: A total of 55 full-text articles were included in the analysis. All studies were retrospective, except for 2 prospective quality of life studies. Five-year tumour control rates with Gamma Knife radiosurgery (RS), single fraction linac RS, or fractionated (either hypofractionated or conventional fractionation) stereotactic radiation therapy (FSRT) were similar at 81-100%. The single fraction RS series (linac or Gamma Knife) with tumour marginal doses between 12 and 14 Gy revealed 5-year tumour control rates of 90-99%, hearing preservation rates of 41-79%, facial nerve preservation rates of 95-100% and trigeminal preservation rates of 79-99%.There were 6 non-randomized studies comparing single fraction RS versus FSRT. There was no statistically significant difference in tumour control; HR=1.66 (95% CI 0.81, 3.42), p =0.17, facial nerve function; HR = 0.67 (95% CI 0.30, 1.49), p =0.33, trigeminal nerve function; HR = 0.80 (95% CI 0.41, 1.56), p =0.51, and hearing preservation; HR = 1.10 (95% CI 0.72, 1.68), p =0.65 comparing single fraction RS with FSRT.Nine quality of life reports yielded conflicting results as to which modality (surgery, observation, or radiation) was associated with better quality of life outcomes.

Conclusions: There are no randomized trials to help guide management of patients with vestibular schwannoma. Within the limitations of the retrospective series, a number of consensus statements were made.

Keywords: acoustic; neuroma; schwannoma; systematic review; vestibular.

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Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Pooled retrospective results of studies which compare single fraction RS versus FSRT for vestibular schwannoma: a) 5 year tumour control; b) 5 year hearing preservation; c) 5 year trigeminal nerve preservation; d) 5 year facial nerve preservation
See this image and copyright information in PMC

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