Outcomes of Repeat Stereotactic Radiosurgery for Recurrent or Progressive Sporadic Vestibular Schwannoma: A Multicenter International Study

Salem M Tos¹, Mariam Ishaque¹, Georgios Mantziaris¹, Bardia Hajikarimaloo¹, Keiss Douri², David Mathieu², Ahmed M Nabeel^{3

4}, Wael A Reda^{3

5}, Sameh R Tawadros^{3

6}, Khaled Abdelkarim^{3

7}, Amr M N El-Shehaby^{3

5}, Reem M Emad^{3

7}, Anais Andrade de Moura⁸, Kenneth Bernstein⁸, Nuria Martinez Moreno⁹, Roberto Martinez Alvarez⁹, David Bailey¹⁰, James McInerney¹⁰, Brad E Zacharia¹⁰, Selcuk Peker¹¹, A Haluk Duzkalir¹¹, Manjul Tripathi¹², Rupinder Kaur¹², Greg N Bowden¹³, Piero Picozzi¹⁴, Andrea Franzini¹⁴, Takuma Sumi¹⁵, Hideyuki Kano¹⁵, Matthew J Shepard¹⁶, Rodney E Wegner¹⁶, Pavnesh Kumar¹⁷, Joshua D Palmer¹⁷, David Schlesinger¹⁸, Chris Z Wei¹⁹, Vanshika Lohia¹⁹, Ajay Niranjan¹⁹, L Dade Lunsford¹⁹, Douglas Kondziolka⁸, Jason P Sheehan¹

Affiliations

¹ Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
² Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada.
³ Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.
⁴ Neurosurgery Department, Benha University, Qalubya, Egypt.
⁵ Neurosurgery Department, Ain Shams University, Cairo, Egypt.
⁶ Clinical Oncology Department, Ain Shams University, Cairo, Egypt.
⁷ Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
⁸ Department of Neurosurgery, NYU Langone, Manhattan, New York, USA.
⁹ Department of Radiosurgery, Rúber Internacional Hospital, Madrid, Spain.
¹⁰ Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
¹¹ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
¹² Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
¹³ Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy.
¹⁵ Neurological Surgery, Dokkyo Medical University, Tochigi, Japan.
¹⁶ Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA.
¹⁷ Radiation Oncology and Neurosurgery, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹⁸ Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA.
¹⁹ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

PMID: 41347795
DOI: 10.1227/neu.0000000000003843

Outcomes of Repeat Stereotactic Radiosurgery for Recurrent or Progressive Sporadic Vestibular Schwannoma: A Multicenter International Study

Salem M Tos et al. Neurosurgery. 2025.

. 2025 Dec 5.

doi: 10.1227/neu.0000000000003843. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
² Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada.
³ Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.
⁴ Neurosurgery Department, Benha University, Qalubya, Egypt.
⁵ Neurosurgery Department, Ain Shams University, Cairo, Egypt.
⁶ Clinical Oncology Department, Ain Shams University, Cairo, Egypt.
⁷ Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
⁸ Department of Neurosurgery, NYU Langone, Manhattan, New York, USA.
⁹ Department of Radiosurgery, Rúber Internacional Hospital, Madrid, Spain.
¹⁰ Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
¹¹ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
¹² Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
¹³ Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy.
¹⁵ Neurological Surgery, Dokkyo Medical University, Tochigi, Japan.
¹⁶ Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA.
¹⁷ Radiation Oncology and Neurosurgery, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹⁸ Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA.
¹⁹ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

PMID: 41347795
DOI: 10.1227/neu.0000000000003843

Abstract

Background and objectives: Repeat stereotactic radiosurgery (SRS) is a noninvasive option for recurrent vestibular schwannoma (VS). This study evaluates outcomes in patients with long-term follow-up.

Methods: This retrospective multicenter study analyzed 81 patients with recurrent unilateral sporadic VS after initial SRS, with ≥12 months of follow-up. Outcomes included tumor control, hearing preservation, cranial nerve function, and adverse radiation effects (ARE). Kaplan-Meier and Cox regression identified factors affecting outcomes.

Results: The median age at the second SRS was 60 years, with a median interval of 58 months between procedures. The median margin doses were 12.0 Gy (single-fraction), 17.25 Gy (3-fraction), and 25 Gy (5-fraction). Tumor control was achieved in 69 patients (85.2%), with 5- and 10-year local control rates of 82% and 76.5%, respectively. Significant predictors of local failure included tumor volume >2.2 cm3 (area under the curve = 0.757, P = .018), prescription biological effective dose (BED) ≤70.3 Gy (hazard ratio [HR]: 0.89, P = .003), and interval between treatments >27.5 months (HR: 1.02, P = .015). In single-fraction SRS, higher prescription dose reduced failure risk (HR: 0.31, P = .002) with a margin dose ≥12 Gy being critical for improved tumor control (P < .001). Serviceable hearing was retained in 12 of 18 cases (66.7%), and facial nerve function was preserved in 72 of 80 cases (90%). ARE occurred in 11 patients (13.6%), most commonly perilesional edema (63.7%). ARE correlated with higher brainstem maximum BED in the entire cohort (HR: 1.02, P = .016) and in single-fraction SRS (HR: 1.02, P = .006). Pseudoprogression (9.8%) was linked to younger age (HR: 0.88, P = .023) and shorter time between SRS (HR: 0.87, P = .012).

Conclusion: Repeat SRS is an effective option for recurrent sporadic VS, offering high tumor control and functional preservation. Outcomes depend on age, interval between treatments, tumor volume, and BED. With careful planning, adverse effects are rare and typically transient.

Keywords: Radiosurgery; Repeat; Retreatment; Sporadic; Vestibular schwannoma.

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References

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Outcomes of Repeat Stereotactic Radiosurgery for Recurrent or Progressive Sporadic Vestibular Schwannoma: A Multicenter International Study

Affiliations

Outcomes of Repeat Stereotactic Radiosurgery for Recurrent or Progressive Sporadic Vestibular Schwannoma: A Multicenter International Study

Authors

Affiliations

Abstract

References

LinkOut - more resources

Full Text Sources