Low-Dose Gamma Knife Radiosurgery for Vestibular Schwannomas

Tumor Control and Cranial Nerve Function Preservation after 11 Gy

Andrew J. Schumacher, Rohan R. Lall, Rishi Rajiv Lall, Allan Nanney Iii, Amit Ayer, Samir Sejpal, Benjamin P. Liu, Maryanne Marymont, Plato Lee, Bernard R. Bendok, John A. Kalapurakal, James P. Chandler

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives This study aims to report tumor control rates and cranial nerve function after low dose (11.0 Gy) Gamma knife radiosurgery (GKRS) in patients with vestibular schwannomas. Methods A retrospective chart review was performed on 30 consecutive patients with vestibular schwannomas treated from March 2004 to August 2010 with GKRS at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. The marginal dose for all patients was 11.0 Gy prescribed to the 50% isodose line. Median follow-up time was 42 months. The median treatment volume was 0.53 cm 3 . Hearing data were obtained from audiometry reports before and after radiosurgery. Results The actuarial progression free survival (PFS) based on freedom from surgery was 100% at 5 years. PFS based on freedom from persistent growth was 91% at 5 years. One patient experienced tumor progression requiring resection at 87 months. Serviceable hearing, defined as Gardner-Robertson score of I-II, was preserved in 50% of patients. On univariate and multivariate analyses, only higher mean and maximum dose to the cochlea significantly decreased the proportion of patients with serviceable hearing. Conclusion Vestibular schwannomas can be treated with low doses (11.0 Gy) of GKRS with good tumor control and cranial nerve preservation.

Original languageEnglish (US)
Pages (from-to)2-10
Number of pages9
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume78
Issue number1
DOIs
StatePublished - Feb 1 2017

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Acoustic Neuroma
Radiosurgery
Cranial Nerves
Hearing
Neoplasms
Disease-Free Survival
Audiometry
Cochlea
Multivariate Analysis
Growth

Keywords

  • acoustic
  • neuroma
  • radiosurgery
  • vestibular schwannoma

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Low-Dose Gamma Knife Radiosurgery for Vestibular Schwannomas : Tumor Control and Cranial Nerve Function Preservation after 11 Gy. / Schumacher, Andrew J.; Lall, Rohan R.; Lall, Rishi Rajiv; Iii, Allan Nanney; Ayer, Amit; Sejpal, Samir; Liu, Benjamin P.; Marymont, Maryanne; Lee, Plato; Bendok, Bernard R.; Kalapurakal, John A.; Chandler, James P.

In: Journal of Neurological Surgery, Part B: Skull Base, Vol. 78, No. 1, 01.02.2017, p. 2-10.

Research output: Contribution to journalArticle

Schumacher, AJ, Lall, RR, Lall, RR, Iii, AN, Ayer, A, Sejpal, S, Liu, BP, Marymont, M, Lee, P, Bendok, BR, Kalapurakal, JA & Chandler, JP 2017, 'Low-Dose Gamma Knife Radiosurgery for Vestibular Schwannomas: Tumor Control and Cranial Nerve Function Preservation after 11 Gy', Journal of Neurological Surgery, Part B: Skull Base, vol. 78, no. 1, pp. 2-10. https://doi.org/10.1055/s-0036-1584231
Schumacher, Andrew J. ; Lall, Rohan R. ; Lall, Rishi Rajiv ; Iii, Allan Nanney ; Ayer, Amit ; Sejpal, Samir ; Liu, Benjamin P. ; Marymont, Maryanne ; Lee, Plato ; Bendok, Bernard R. ; Kalapurakal, John A. ; Chandler, James P. / Low-Dose Gamma Knife Radiosurgery for Vestibular Schwannomas : Tumor Control and Cranial Nerve Function Preservation after 11 Gy. In: Journal of Neurological Surgery, Part B: Skull Base. 2017 ; Vol. 78, No. 1. pp. 2-10.
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abstract = "Objectives This study aims to report tumor control rates and cranial nerve function after low dose (11.0 Gy) Gamma knife radiosurgery (GKRS) in patients with vestibular schwannomas. Methods A retrospective chart review was performed on 30 consecutive patients with vestibular schwannomas treated from March 2004 to August 2010 with GKRS at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. The marginal dose for all patients was 11.0 Gy prescribed to the 50{\%} isodose line. Median follow-up time was 42 months. The median treatment volume was 0.53 cm 3 . Hearing data were obtained from audiometry reports before and after radiosurgery. Results The actuarial progression free survival (PFS) based on freedom from surgery was 100{\%} at 5 years. PFS based on freedom from persistent growth was 91{\%} at 5 years. One patient experienced tumor progression requiring resection at 87 months. Serviceable hearing, defined as Gardner-Robertson score of I-II, was preserved in 50{\%} of patients. On univariate and multivariate analyses, only higher mean and maximum dose to the cochlea significantly decreased the proportion of patients with serviceable hearing. Conclusion Vestibular schwannomas can be treated with low doses (11.0 Gy) of GKRS with good tumor control and cranial nerve preservation.",
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AU - Iii, Allan Nanney

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AU - Liu, Benjamin P.

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AB - Objectives This study aims to report tumor control rates and cranial nerve function after low dose (11.0 Gy) Gamma knife radiosurgery (GKRS) in patients with vestibular schwannomas. Methods A retrospective chart review was performed on 30 consecutive patients with vestibular schwannomas treated from March 2004 to August 2010 with GKRS at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. The marginal dose for all patients was 11.0 Gy prescribed to the 50% isodose line. Median follow-up time was 42 months. The median treatment volume was 0.53 cm 3 . Hearing data were obtained from audiometry reports before and after radiosurgery. Results The actuarial progression free survival (PFS) based on freedom from surgery was 100% at 5 years. PFS based on freedom from persistent growth was 91% at 5 years. One patient experienced tumor progression requiring resection at 87 months. Serviceable hearing, defined as Gardner-Robertson score of I-II, was preserved in 50% of patients. On univariate and multivariate analyses, only higher mean and maximum dose to the cochlea significantly decreased the proportion of patients with serviceable hearing. Conclusion Vestibular schwannomas can be treated with low doses (11.0 Gy) of GKRS with good tumor control and cranial nerve preservation.

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