The role of stereotactic radiosurgery in the management of vestibular schwannoma in octogenarians: an international multi-institutional study.
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Abou-Al-Shaar Hussam, Albalkhi Ibrahem, Bin-Alamer Othman, Head Jeffery R, Mallela Arka N, Wegner Rodney E, Kite Trent, Mahase Sean S, Nolan Kara, Zacharia Brad E, Bailey David, Lee Cheng-Chia, Yang Huai-Che, Bowden Greg N, Hajikarimloo Bardia, Lin Michelle, Yu Cheng, Chang Eric, Amezquita-Contreras Christian, Blanco Angel I, Esquenazi Yoshua, Kumar Pavnesh, Palmer Joshua D, Franzini Andrea, Picozzi Piero, Cotrufo Pietro Paolo, Douri Keiss, Mathieu David, Grover Patrick, Williams Simon C, Sinha Siddharth, Comon Charlotte, Jalal Arif, Sirajudeen Nazir, Markov Mark, Kılıç Türker, Rustamov Rovshan, Kılıç Deniz, Harary Paul M, Hori Yusuke S, Park David J, Chang Steven D, Düzkalir Ali Haluk, Peker Selcuk, Urgošík Dušan, Liščák Roman, Warnick Ronald E, Tripathi Manjul, Bhatta Rajkumar, Kumar Narendra, Andrade Anais, Mureb Monica, Bernstein Kenneth, Martínez Moreno Nuria, Martínez-Álvarez Roberto, Zada Gabriel, Sheehan Jason P, Kondziolka Douglas, Niranjan Ajay, Hadjipanayis Constantinos G, Lunsford L Dade
Аннотация
METHODS: The authors retrospectively analyzed the data of octogenarians with VS managed with SRS across 27 institutions, assessing clinical and audiological outcomes, including survival rates, tumor control responses, complications, and posttreatment functional outcomes.
RESULTS: Among 309 octogenarians with VS managed with single-fraction SRS, overall survival was 97.8% at 1 year, 88.5% at 3 years, and 78.1% at 5 years; the corresponding progression-free survival rates were 95.8%, 81.1%, and 71.1%, respectively. In competing risk analysis, tumor progression occurred in 5.2% of patients by 5 years, whereas death without progression reached 19.8%. Tumor control was achieved in 94.8% at 3 and 5 years. At last imaging follow-up (median 33.5 months, IQR 14-60 months), 29.1% showed volume regression. Communicating hydrocephalus developed in 4.2% and was successfully managed with CSF diversion. Age, sex, tumor volume, Koos grade, and margin dose were not significant predictors of patient survival or tumor progression.
CONCLUSIONS: Single-fraction SRS is a safe and effective management modality for octogenarians with VS, providing durable tumor control with minimal morbidity.