Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk.
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Bin-Alamer Othman, Faramand Andrew, Alarifi Norah A, Wei Zhishuo, Mallela Arka N, Lu Victor M, Nabeel Ahmed M, Reda Wael A, Tawadros Sameh R, Abdelkarim Khaled, El-Shehaby Amr M N, Emad Reem M, Peker Selcuk, Samanci Yavuz, Lee Cheng-Chia, Yang Huai-Che, Delabar Violaine, Mathieu David, Tripathi Manjul, Kearns Kathryn Nicole, Bunevicius Adomas, Sheehan Jason P, Chytka Tomas, Liscak Roman, Moreno Nuria Martínez, Álvarez Roberto Martínez, Grills Inga S, Parzen Jacob S, Cifarelli Christopher P, Rehman Azeem A, Speckter Herwin, Niranjan Ajay, Lunsford L Dade, Abou-Al-Shaar Hussam
Аннотация
OBJECTIVE: To evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiation-related risks of patients with NF2 after SRS for VS.
METHODS: We performed a retrospective study of 267 patients with NF2 (328 VSs) who underwent single-session SRS at 12 centers participating in the International Radiosurgery Research Foundation. The median patient age was 31 years (IQR, 21-45 years), and 52% were male.
RESULTS: A total of 328 tumors underwent SRS during a median follow-up time of 59 months (IQR, 23-112 months). At 10 and 15 years, the tumor control rates were 77% (95% CI: 69%-84%) and 52% (95% CI: 40%-64%), respectively, and the FFAT rate were 85% (95% CI: 79%-90%) and 75% (95% CI: 65%-86%), respectively. At 5 and 10 years, the serviceable hearing preservation rates were 64% (95% CI: 55%-75%) and 35% (95% CI: 25%-54%), respectively. In the multivariate analysis, age (hazards ratio: 1.03 [95% CI: 1.01-1.05]; P = .02) and bilateral VSs (hazards ratio: 4.56 [95% CI: 1.05-19.78]; P = .04) were predictors for serviceable hearing loss. Neither radiation-induced tumors nor malignant transformation were encountered in this cohort.
CONCLUSION: Although the absolute volumetric tumor progression rate was 48% at 15 years, the rate of FFAT related to VS was 75% at 15 years after SRS. None of the patients with NF2-related VS developed a new radiation-related neoplasm or malignant transformation after SRS.