Vestibular Schwannoma International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS Study.
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Bin-Alamer Othman, Abou-Al-Shaar Hussam, Peker Selcuk, Samanci Yavuz, Pelcher Isabelle, Begley Sabrina, Goenka Anuj, Schulder Michael, Tourigny Jean-Nicolas, Mathieu David, Hamel Andréanne, Briggs Robert G, Yu Cheng, Zada Gabriel, Giannotta Steven L, Speckter Herwin, Palque Sarai, Tripathi Manjul, Kumar Saurabh, Kaur Rupinder, Kumar Narendra, Rogowski Brandon, Shepard Matthew J, Johnson Bryan A, Trifiletti Daniel M, Warnick Ronald E, Dayawansa Samantha, Mashiach Elad, Vasconcellos Fernando De Nigris, Bernstein Kenneth, Schnurman Zane, Alzate Juan, Kondziolka Douglas, Sheehan Jason P
Аннотация
METHODS AND MATERIALS: This multicenter study analyzed data from Koos grade 1 and 2 VS patients managed with SRS (SRS group) or observation (observation group). Propensity score matching balanced patient demographics, tumor volume, and audiometry. Outcomes measured were tumor control, serviceable hearing preservation, and neurological outcomes.
RESULTS: In 125 matched patients in each group with a 36-month median follow-up (P = .49), SRS yielded superior 5- and 10-year tumor control rates (99% CI, 97.1%-100%, and 91.9% CI, 79.4%-100%) versus observation (45.8% CI, 36.8%-57.2%, and 22% CI, 13.2%-36.7%; P < .001). Serviceable hearing preservation rates at 5 and 9 years were comparable (SRS 60.4% CI, 49.9%-73%, vs observation 51.4% CI, 41.3%-63.9%, and SRS 27% CI, 14.5%-50.5%, vs observation 30% CI, 17.2%-52.2%; P = .53). SRS were associated with lower odds of tinnitus (OR = 0.39, P = .01), vestibular dysfunction (OR = 0.11, P = .004), and any cranial nerve palsy (OR = 0.36, P = .003), with no change in cranial nerves 5 or 7 (P > .05). Composite endpoints of tumor progression and/or any of the previous outcomes showed significant lower odds associated with SRS compared with observation alone (P < .001).
CONCLUSIONS: SRS management in matched cohorts of Koos grade 1 and 2 VS patients demonstrated superior tumor control, comparable hearing preservation rates, and significantly lower odds of experiencing neurological deficits. These findings delineate the safety and efficacy of SRS in the management of this patient population.