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Článek

Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

Bin-Alamer, Othman
Autor Bin-Alamer, Othman ORCID Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Faramand, Andrew
Autor Faramand, Andrew Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Alarifi, Norah A
Autor Alarifi, Norah A Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA Department of Neurosurgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Wei, Zhishuo
Autor Wei, Zhishuo Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Mallela, Arka N
Autor Mallela, Arka N Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Lu, Victor M
Autor Lu, Victor M Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
Nabeel, Ahmed M
Autor Nabeel, Ahmed M Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt Neurosurgery Department, Benha University, Qalubya, Egypt
Reda, Wael A
Autor Reda, Wael A Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt Neurosurgery Department, Ain Shams University, Cairo, Egypt
Tawadros, Sameh R
Autor Tawadros, Sameh R Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt Neurosurgery Department, Ain Shams University, Cairo, Egypt
Abdelkarim, Khaled
Autor Abdelkarim, Khaled Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt Clinical Oncology Department, Ain Shams University, Cairo, Egypt

Neurosurgery. 2023 ; 92 (5) : 934-944. [pub] 20230302

ISSN 1524-4040
Medvik
Zdroj

BACKGROUND: Vestibular schwannomas (VSs) related to neurofibromatosis type 2 (NF2) are challenging tumors. The increasing use of stereotactic radiosurgery (SRS) necessitates further investigations of its role and safety. OBJECTIVE: To evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiation-related risks of patients with NF2 after SRS for VS. METHODS: We performed a retrospective study of 267 patients with NF2 (328 VSs) who underwent single-session SRS at 12 centers participating in the International Radiosurgery Research Foundation. The median patient age was 31 years (IQR, 21-45 years), and 52% were male. RESULTS: A total of 328 tumors underwent SRS during a median follow-up time of 59 months (IQR, 23-112 months). At 10 and 15 years, the tumor control rates were 77% (95% CI: 69%-84%) and 52% (95% CI: 40%-64%), respectively, and the FFAT rate were 85% (95% CI: 79%-90%) and 75% (95% CI: 65%-86%), respectively. At 5 and 10 years, the serviceable hearing preservation rates were 64% (95% CI: 55%-75%) and 35% (95% CI: 25%-54%), respectively. In the multivariate analysis, age (hazards ratio: 1.03 [95% CI: 1.01-1.05]; P = .02) and bilateral VSs (hazards ratio: 4.56 [95% CI: 1.05-19.78]; P = .04) were predictors for serviceable hearing loss. Neither radiation-induced tumors nor malignant transformation were encountered in this cohort. CONCLUSION: Although the absolute volumetric tumor progression rate was 48% at 15 years, the rate of FFAT related to VS was 75% at 15 years after SRS. None of the patients with NF2-related VS developed a new radiation-related neoplasm or malignant transformation after SRS.