Stereotactic radiosurgery for Koos grade IV vestibular schwannoma in patients ≥ 65 years old: a multi-institutional retrospective study.
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Dumot Chloe, Pikis Stylianos, Mantziaris Georgios, Xu Zhiyuan, Dayawansa Sam, Anand Rithika Kormath, Nabeel Ahmed M, Sheehan Darrah, Sheehan Kimball, Reda Wael A, Tawadros Sameh R, Karim Khaled Abdel, El-Shehaby Amr M N, Eldin Reem M Emad, Peker Selcuk, Samanci Yavuz, Kaisman-Elbaz Tehila, Speckter Herwin, Hernández Wenceslao, Isidor Julio, Tripathi Manjul, Madan Renu, Zacharia Brad E, Daggubati Lekhaj C, Moreno Nuria Martínez, Álvarez Roberto Martínez, Langlois Anne-Marie, Mathieu David, Deibert Christopher P, Sudhakar Vivek R, Cifarelli Christopher P, Icaza Denisse Arteaga, Cifarelli Daniel T, Wei Zhishuo, Niranjan Ajay, Barnett Gene H, Lunsford L Dade, Bowden Greg N, Sheehan Jason P
Аннотация
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.