Document Detail


Long-term outcomes of vestibular schwannomas treated with fractionated stereotactic radiotherapy: an institutional experience.
MedLine Citation:
PMID:  20884130     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma.
METHODS AND MATERIALS: Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radiotherapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms.
RESULTS: In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm(3) were 18.02 times more likely to progress than those with tumor volumes of 1 cm(3) or greater (odds ratio, 18.02; 95% confidence interval, 4.25-76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia.
CONCLUSIONS: Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the "no salvage surgery needed" and "no additional treatment needed" criteria for treatment success need to be complemented by the radiologic data.
Authors:
Sumit Kapoor; Sachin Batra; Kathryn Carson; John Shuck; Siddharth Kharkar; Rahul Gandhi; Juan Jackson; Jan Wemmer; Stephanie Terezakis; Ori Shokek; Lawrence Kleinberg; Daniele Rigamonti
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-29
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  81     ISSN:  1879-355X     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-10     Completed Date:  2011-12-07     Revised Date:  2014-06-04    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  647-53     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Disease Progression
Dose Fractionation
Female
Humans
Hydrocephalus / etiology
Male
Microsurgery / methods
Middle Aged
Neuroma, Acoustic / pathology,  radiography,  surgery*
Paresthesia / etiology
Radiosurgery / adverse effects,  methods*
Regression Analysis
Salvage Therapy / methods
Sex Factors
Treatment Failure
Trigeminal Nerve Diseases / etiology
Tumor Burden
Grant Support
ID/Acronym/Agency:
P30 CA006973/CA/NCI NIH HHS
Comments/Corrections
Comment In:
Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):1324   [PMID:  22385724 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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