TY - JOUR
T1 - Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old
T2 - a multi-institutional retrospective study
AU - Dumot, Chloe
AU - Pikis, Stylianos
AU - Mantziaris, Georgios
AU - Xu, Zhiyuan
AU - Dayawansa, Sam
AU - Anand, Rithika Kormath
AU - Nabeel, Ahmed M.
AU - Sheehan, Darrah
AU - Sheehan, Kimball
AU - Reda, Wael A.
AU - Tawadros, Sameh R.
AU - Karim, Khaled Abdel
AU - El-Shehaby, Amr M.N.
AU - Eldin, Reem M.Emad
AU - Peker, Selcuk
AU - Samanci, Yavuz
AU - Kaisman-Elbaz, Tehila
AU - Speckter, Herwin
AU - Hernández, Wenceslao
AU - Isidor, Julio
AU - Tripathi, Manjul
AU - Madan, Renu
AU - Zacharia, Brad E.
AU - Daggubati, Lekhaj C.
AU - Moreno, Nuria Martínez
AU - Álvarez, Roberto Martínez
AU - Langlois, Anne Marie
AU - Mathieu, David
AU - Deibert, Christopher P.
AU - Sudhakar, Vivek R.
AU - Cifarelli, Christopher P.
AU - Icaza, Denisse Arteaga
AU - Cifarelli, Daniel T.
AU - Wei, Zhishuo
AU - Niranjan, Ajay
AU - Barnett, Gene H.
AU - Lunsford, L. Dade
AU - Bowden, Greg N.
AU - Sheehan, Jason P.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Surgery is the preferred treatment for large vestibular schwannomas (VS). Good tumor control and cranial nerve outcomes were described in selected Koos IV VS after single-session stereotactic radiosurgery (SRS), but outcomes in elderly patients have never been specifically studied. The aim of this study is to report clinical and radiological outcomes after single-session SRS for Koos IV VS in patients ≥ 65 years old. Method: This multicenter, retrospective study included patients ≥ 65 years old, treated with primary, single-session SRS for a Koos IV VS, and at least 12 months of follow-up. Patients with life-threatening or incapacitating symptoms were excluded. Tumor control rate, hearing, trigeminal, and facial nerve function were studied at last follow-up. Results: One-hundred and fifty patients (median age of 71.0 (IQR 9.0) years old with a median tumor volume of 8.3 cc (IQR 4.4)) were included. The median prescription dose was 12.0 Gy (IQR 1.4). The local tumor control rate was 96.0% and 86.2% at 5 and 10 years, respectively. Early tumor expansion occurred in 6.7% and was symptomatic in 40% of cases. A serviceable hearing was present in 16.1% prior to SRS and in 7.4% at a last follow-up of 46.5 months (IQR 55.8). The actuarial serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively. Facial nerve function preservation or improvement rates at 5 and 10 years were 98.7% and 91.0%, respectively. At last follow-up, the trigeminal nerve function was improved in 14.0%, stable in 80.7%, and worsened in 5.3% of the patients. ARE were noted in 12.7%. New hydrocephalus was seen in 8.0% of patients. Conclusion: SRS can be a safe alternative to surgery for selected Koos IV VS in patients ≥ 65 years old. Further follow-up is warranted.
AB - Background: Surgery is the preferred treatment for large vestibular schwannomas (VS). Good tumor control and cranial nerve outcomes were described in selected Koos IV VS after single-session stereotactic radiosurgery (SRS), but outcomes in elderly patients have never been specifically studied. The aim of this study is to report clinical and radiological outcomes after single-session SRS for Koos IV VS in patients ≥ 65 years old. Method: This multicenter, retrospective study included patients ≥ 65 years old, treated with primary, single-session SRS for a Koos IV VS, and at least 12 months of follow-up. Patients with life-threatening or incapacitating symptoms were excluded. Tumor control rate, hearing, trigeminal, and facial nerve function were studied at last follow-up. Results: One-hundred and fifty patients (median age of 71.0 (IQR 9.0) years old with a median tumor volume of 8.3 cc (IQR 4.4)) were included. The median prescription dose was 12.0 Gy (IQR 1.4). The local tumor control rate was 96.0% and 86.2% at 5 and 10 years, respectively. Early tumor expansion occurred in 6.7% and was symptomatic in 40% of cases. A serviceable hearing was present in 16.1% prior to SRS and in 7.4% at a last follow-up of 46.5 months (IQR 55.8). The actuarial serviceable hearing preservation rate was 69.3% and 50.9% at 5 and 10 years, respectively. Facial nerve function preservation or improvement rates at 5 and 10 years were 98.7% and 91.0%, respectively. At last follow-up, the trigeminal nerve function was improved in 14.0%, stable in 80.7%, and worsened in 5.3% of the patients. ARE were noted in 12.7%. New hydrocephalus was seen in 8.0% of patients. Conclusion: SRS can be a safe alternative to surgery for selected Koos IV VS in patients ≥ 65 years old. Further follow-up is warranted.
KW - Elderly
KW - Koos grade IV
KW - Stereotactic radiosurgery
KW - Vestibular schwannoma
UR - http://www.scopus.com/inward/record.url?scp=85144549023&partnerID=8YFLogxK
U2 - 10.1007/s00701-022-05454-w
DO - 10.1007/s00701-022-05454-w
M3 - Article
C2 - 36543963
AN - SCOPUS:85144549023
SN - 0001-6268
VL - 165
SP - 211
EP - 220
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 1
ER -