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Multicenter Study
. 2022 Oct;160(1):201-208.
doi: 10.1007/s11060-022-04134-0. Epub 2022 Sep 27.

Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in young patients: a multi-institutional study

Chloe Dumot  1   2 , Stylianos Pikis  1 , Georgios Mantziaris  1 , Zhiyuan Xu  1 , Rithika Kormath Anand  1 , Ahmed M Nabeel  3   4 , Darrah Sheehan  1 , Kimball Sheehan  1 , Wael A Reda  3   5 , Sameh R Tawadros  3   5 , Khaled Abdel Karim  3   6 , Amr M N El-Shehaby  3   5 , Reem M Emad Eldin  3   7 , Selcuk Peker  8 , Yavuz Samanci  8 , Tehila Kaisman-Elbaz  9 , Herwin Speckter  10 , Wenceslao Hernández  10 , Julio Isidor  10 , Manjul Tripathi  11 , Renu Madan  12 , Brad E Zacharia  13 , Lekhaj C Daggubati  13 , Nuria Martínez Moreno  14 , Roberto Martínez Álvarez  14 , Anne-Marie Langlois  15 , David Mathieu  15 , Christopher P Deibert  16 , Vivek R Sudhakar  17 , Christopher P Cifarelli  17   18 , Denisse Arteaga Icaza  17 , Daniel T Cifarelli  17 , Zhishuo Wei  19 , Ajay Niranjan  19 , Gene H Barnett  9 , L Dade Lunsford  19 , Greg N Bowden  20 , Jason P Sheehan  21
Affiliations
Multicenter Study

Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in young patients: a multi-institutional study

Chloe Dumot et al. J Neurooncol. 2022 Oct.

Abstract

Purpose: Surgery is the treatment of choice for large vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has been suggested as an alternative to resection in selected patients. However, the safety and efficacy of SRS in Koos grade IV patients ≤ 45 years old has not been evaluated. The aim of this study is to describe the clinical and radiological outcomes of Koos grade IV in young patient managed with a single-session SRS.

Methods: This retrospective, multicenter analysis included SRS-treated patients, ≤ 45 years old presenting with non-life threatening or incapacitating symptoms due to a Koos Grade IV VS and with follow-up ≥ 12 months. Tumor control and neurological outcomes were evaluated.

Results: 176 patients [median age of 36.0 (IQR 9) and median tumor volume of 9.3 cm3 (IQR 4.7)] were included. The median prescription dose was 12 Gy (IQR 0.5). Median follow-up period was 37.5 (IQR 53.5) months. The 5- and 10-year progression-free survival was 90.9% and 86.7%. Early tumor enlargement occurred in 10.9% of cases and was associated with tumor progression at the last follow-up. The probability of serviceable hearing preservation at 5- and 10-years was 56.8% and 45.2%, respectively. The probability of improvement or preservation of facial nerve function was 95.7% at 5 and 10-years. Adverse radiation effects were noted in 19.9%. New-onset hydrocephalus occurred in 4.0%.

Conclusion: Single-session SRS is a safe and effective alternative to surgical resection in selected patients ≤ 45 years old particularly those with medical co-morbidities and those who decline resection. Longer term follow up is warranted.

Keywords: Koos grade IV; Stereotactic radiosurgery; Vestibular schwannoma; Young age.

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References

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