Radiotherapy for Growing Vestibular Schwannomas.
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Sethi Mantegh, Gowrishankar Shravan, Tysome James, Donnelly Neil, Axon Patrick, Bance Manohar, Mannion Richard, Guilfoyle Mathew, Buttimore Juliette, Gamazo Nicola, Duke Simon, Jena Raj, Burton Katherine, Jefferies Sarah, Fornezza Umberto, Perini Zeno, Mari Cristina, Gazzola Luca, Schouten Sammy, Compter Inge, Eekers Daniëlle B P, Kunst Henricus P M, Bassi Rohan, MacKeith Samuel, Jeyaretna Sanjeeva, Whitfield Gillian, McBain Catherine, Colaco Rovel, Hotchkies Angus, Lloyd Simon, Obholzer Rupert, Cheang Ya Fang Amanda, Thomas Nick, Barazi Sinan, Maratos Eleni, Shapey Jonathan, Hassan Sheila, Tancu Cornel, Kitchen Neil, Marinelli John P, Carlson Matthew L, Link Michael J, Borsetto Daniele
Аннотация
OBJECTIVE: To estimate tumor control rates in radiologically growing VS treated with first-line radiotherapy.
DESIGN, SETTING, AND PARTICIPANTS: This international, multicenter cohort study used prospectively collected data from patients with growing unilateral VS treated first-line with radiotherapy between January 2000 and December 2023 from 8 tertiary referral skull base units. The data were analyzed in June 2025.
EXPOSURES: Radiotherapy as an initial treatment for VS.
MAIN OUTCOMES AND MEASURES: The primary outcome was treatment failure, ie VS growth postradiotherapy, which was predefined as an increase in maximum intracranial tumor diameter (ICTD) of 3 mm or greater within the first 2 years after radiotherapy or 2 mm or greater thereafter. Secondary outcomes were treatment failure based on different definitions of VS growth: (1) an increase in ICTD of 2 mm or greater, (2) an increase in ICTD of 3 mm or greater, and (3) conversion to surgery.
RESULTS: A total of 1883 patients (975 female individuals [51.8%]; median age at diagnosis, 63 years [IQR, 53-71 years]) were included in the study. Using the primary definition of treatment failure (an increase in ICTD of ≥3 mm within the first 2 years postradiotherapy or ≥2 mm thereafter), the Kaplan-Meier estimate yielded a 10-year tumor control rate of 76.1% (95% CI, 72.7%-79.2%). For secondary outcome definitions, 10-year tumor control rates were 60.1% (95% CI, 57.5%-64.3%) for an ICTD increase of 2 mm or greater, 78.3% (95% CI, 75.0%-81.2%) for an increase of 3 mm or greater, and 92.6% (95% CI, 90.4%-94.3%) for conversion to surgery. Neither pretreatment tumor size nor tumor location (intracanalicular vs extracanalicular) were significantly associated with treatment failure.
CONCLUSIONS AND RELEVANCE: The results of this cohort study provide tumor control outcomes for radiologically growing VS treated with radiotherapy using several clinically relevant definitions of growth. By focusing exclusively on this rarely isolated subgroup, the findings offer targeted data to potentially inform treatment expectations and future research.