Journal of spine surgery (Hong Kong) · 2026
Stereotactic radiosurgery for NF2-related schwannomatosis and schwannomatosis-associated spinal tumors: a single-institution cohort.
СтатьяНазвание и аннотация: Перевод в очереди
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Sanker Vivek, Urdaneta Adrian, Kattaa Ahed H, Li Zhikai, Miller Rebekka, Park Chelsea, Frantzias Joseph, Park David J, Chang Steven D, Desai Atman
Аннотация
BACKGROUND: Neurofibromatosis type 2 (NF2)-related schwannomatosis and other schwannomatosis subtypes frequently involve multiple spinal nerve-sheath tumors. While stereotactic radiosurgery (SRS) is well established for intracranial disease, long-term spinal outcomes in genetically predisposed populations remain limited. Existing spinal SRS studies often include heterogeneous tumor types, limited follow-up and/or mixed sporadic and syndromic cohorts. This study reports a 21-year single-institution experience, including rare long-term follow-up extending to 19 years.
METHODS: We retrospectively reviewed 13 patients with NF2-related schwannomatosis, schwannomatosis-not otherwise specified (schwannomatosis-NOS), or misclassified NF1 who underwent CyberKnife SRS for 23 spinal tumors between 2004-2025. Demographics, tumor characteristics, GTV/PTV definitions, dose constraints, and CTCAE-graded toxicities were recorded. Radiographic control and functional outcomes were assessed.
RESULTS: Median age was 39 years (interquartile range, 24-49 years); 69.2% were male. Tumors included 15 schwannomas (65.2%), 7 neurofibromas (30.4%), and 1 meningioma (4.3%). Mean prescription dose was 18.5±2.7 Gy (median 1 fraction). CTCAE-graded toxicities included Grade 1-2 sensory symptoms (15.3%) and Grade 1-2 motor symptoms (15.3%); no Grade ≥3 events occurred. At follow-up, 17.4% regressed and 34.8% remained stable. Functional improvement occurred in 22.2% of evaluable lesions. One radiographic recurrence (4.3%) was identified. Illustrative cases demonstrated feasible and durable long-term control, including an 8-year stable cervical neurofibroma treated at age 18 years, a thoracolumbar schwannoma case with 9-year stability across multiple treated levels, and a lumbar schwannoma achieving local control without acute toxicity following hypofractionated SRS.
CONCLUSIONS: SRS may be considered a safe, targeted option for selected spinal tumors in NF2-related schwannomatosis, particularly in cervical lesions. Prospective studies incorporating molecular stratification and adaptive radiotherapy are warranted.
METHODS: We retrospectively reviewed 13 patients with NF2-related schwannomatosis, schwannomatosis-not otherwise specified (schwannomatosis-NOS), or misclassified NF1 who underwent CyberKnife SRS for 23 spinal tumors between 2004-2025. Demographics, tumor characteristics, GTV/PTV definitions, dose constraints, and CTCAE-graded toxicities were recorded. Radiographic control and functional outcomes were assessed.
RESULTS: Median age was 39 years (interquartile range, 24-49 years); 69.2% were male. Tumors included 15 schwannomas (65.2%), 7 neurofibromas (30.4%), and 1 meningioma (4.3%). Mean prescription dose was 18.5±2.7 Gy (median 1 fraction). CTCAE-graded toxicities included Grade 1-2 sensory symptoms (15.3%) and Grade 1-2 motor symptoms (15.3%); no Grade ≥3 events occurred. At follow-up, 17.4% regressed and 34.8% remained stable. Functional improvement occurred in 22.2% of evaluable lesions. One radiographic recurrence (4.3%) was identified. Illustrative cases demonstrated feasible and durable long-term control, including an 8-year stable cervical neurofibroma treated at age 18 years, a thoracolumbar schwannoma case with 9-year stability across multiple treated levels, and a lumbar schwannoma achieving local control without acute toxicity following hypofractionated SRS.
CONCLUSIONS: SRS may be considered a safe, targeted option for selected spinal tumors in NF2-related schwannomatosis, particularly in cervical lesions. Prospective studies incorporating molecular stratification and adaptive radiotherapy are warranted.