PURPOSE: When gamma knife radiosurgery (GKS) does not achieve control of the growth of a tumour, the need to repeat treatment is considered. The results and risks of repeat treatment of patients with a vestibular schwannoma were reviewed to assess its efficacy and safety.

• MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru epidemiologie   chirurgie   MeSH
• mladý dospělý MeSH
• nervus vestibularis chirurgie   patologie   MeSH
• neurochirurgické výkony statistika a číselné údaje   MeSH
• percepční nedoslýchavost epidemiologie   MeSH
• pooperační komplikace epidemiologie   MeSH
• poranění nervus facialis epidemiologie   MeSH
• radiochirurgie metody   statistika a číselné údaje   škodlivé účinky   MeSH
• reoperace statistika a číselné údaje   škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vestibulární schwannom chirurgie   patofyziologie   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

OBJECTIVES: Stereotactic radiosurgery (SRS) is an established treatment option of small/medium-sized vestibular schwannomas (VSs). Concerning management of the large VSs, primary SRS remains a controversial option. Our retrospective study analyzes long-term radiological and clinical outcomes of SRS in large VSs. MATERIAL AND METHODS: We retrospectively analyzed 73 patients with single large VS, treated with SRS. Inclusion criteria were: tumor volume >4 cm3, follow-up >2 years, radiological (3D-volumetric studies) and clinical follow-up. SRS was either primary (94.5%) or secondary (5.5%) treatment. The median marginal dose (50%-isodose line) was 12Gy (11.5-12Gy). Fisher exact test, t-test, ANOVA, Kaplan-Meier and Cox regression models were performed when appropriate RESULTS: The median follow-up was 5.5 years. The median VS volume at SRS was 6.5 cm3 (range 4-14.2 cm3). The tumor control rates assessed from Kaplan-Meier curve were 88.3%, 82.4% and 74.7% 5.8 and 10 years after SRS, respectively. Tumor shrinkage was observed in 83.6% of patients (n=61), unchanged volume in 4.1% patients (n=3) and progression in 12.3% (n=9). The median tumor volume significantly decreased to 4.0 cm3, measured at 5-year follow-up (p<0.0001). Large cystic VSs responded better to SRS then homogeneous. Pre-SRS serviceable hearing was present in 37% of patients; 55% of these had hearing preserved after treatment. After SRS, new facial palsy (House-Brackmann gr. III-VI) appeared in 4.1% of patients; 9.6% of patients had transient brainstem/cranial nerves edema. For tumor progression, 8.2% of patients underwent resection, 2.8% of patients repeated SRS. CONCLUSION: Our results are showing that SRS might be safe and effective primary treatment even in large VSs. However, long-term tumor control rates are lower in comparison with small/medium-sized VSs. Thus, closer follow-up should be applied.

• MeSH
• lidé MeSH
• následné studie MeSH
• radiochirurgie * MeSH
• retrospektivní studie MeSH
• tumor burden MeSH
• vestibulární schwannom * diagnostické zobrazování   radioterapie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Stereotactic radiosurgery (SRS) is a highly effective management approach for patients with vestibular schwannomas (VS), with 10-yr control rates up 98%. When it fails, however, few data are available to guide management. OBJECTIVE: To perform a retrospective analysis of patients who underwent 2 SRS procedures on the same VS to assess the safety and efficacy of this practice. METHODS: This study was opened to centers of the International Gamma Knife Research Foundation (IGKRF). Data collected included patient characteristics, clinical symptoms at the time of SRS, radiosurgery dosimetric data, imaging response, clinical evolution, and survival. Actuarial analyses of tumor responses were performed. RESULTS: Seventy-six patients from 8 IGKRF centers were identified. Median follow-up from the second SRS was 51.7 mo. Progression after the first SRS occurred at a median of 43 mo. Repeat SRS was performed using a median dose of 12 Gy. Actuarial tumor control rates at 2, 5, and 10 yr following the second SRS were 98.6%, 92.2%, and 92.2%, respectively. Useful hearing was present in 30%, 8%, and 5% of patients at first SRS, second SRS, and last follow-up, respectively. Seventy-five percent of patients reported stable or improved symptoms following the second SRS. Worsening of facial nerve function attributable to SRS occurred in 7% of cases. There were no reports of radionecrosis, radiation-associated edema requiring corticosteroids, radiation-related neoplasia, or death attributable to the repeat SRS procedure. CONCLUSION: Patients with progressing VS after radiosurgery can be safely and effectively managed using a second SRS procedure.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru chirurgie   MeSH
• progrese nemoci MeSH
• radiochirurgie metody   MeSH
• reoperace * MeSH
• retrospektivní studie MeSH
• senioři MeSH
• vestibulární schwannom chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH