Stereotactic radiosurgery: The preferred management for patients with nonvestibular schwannomas?

Bruce E. Pollock, Robert L. Foote, Scott L. Stafford

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Purpose: To review patient outcomes after radiosurgery of nonvestibular schwannomas. Methods and Materials: From April 1992 to February 2000, 23 patients had radiosurgery at our center for nonvestibular schwannomas. Affected cranial nerves included the trochlear (n = 1), trigeminal (n = 10), jugular foramen region (n = 10), and hypoglossal (n = 2). Nine patients had undergone one or more prior tumor resections. One patient had a malignant schwannoma; 2 patients had neurofibromatosis. The median prescription isodose volume was 8.9 cc (range, 0.2 to 17.6 cc). The median tumor margin dose was 18 Gy (range, 12 to 20 Gy); the median maximum dose was 36 Gy (range, 24 to 40 Gy). The median follow-up after radiosurgery was 43 months (range, 12 to 111 months). Results: Twenty-two of 23 tumors (96%) were either smaller (n = 12) or unchanged in size (n = 10) after radiosurgery. One patient with a malignant schwannoma had tumor progression outside the irradiated volume despite having both radiosurgery and fractionated radiation therapy (50.4 Gy); he died 4 years later. Morbidity related to radiosurgery occurred in 4 patients (17%). Three of 10 patients with trigeminal schwannomas suffered new or worsened trigeminal dysfunction after radiosurgery. One patient with a hypoglossal schwannoma had eustachian tube dysfunction after radiosurgery. No patient with a lower cranial nerve schwannoma developed any hearing loss, facial weakness, or swallowing difficulty after radiosurgery. Conclusions: Although the reported number of patients having radiosurgery for nonvestibular schwannomas is limited, the high tumor control rates demonstrated after vestibular schwannoma radiosurgery should apply to these rare tumors. Compared to historical controls treated with surgical resection, radiosurgery appears to have less treatment-associated morbidity for nonvestibular schwannomas, especially for schwannomas involving the lower cranial nerves.

Original languageEnglish (US)
Pages (from-to)1002-1007
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume52
Issue number4
DOIs
StatePublished - Mar 15 2002

Fingerprint

Radiosurgery
Neurilemmoma
tumors
nerves
Cranial Nerves
Neoplasms
eustachian tubes
dosage
auditory defects
Morbidity
Eustachian Tube
Neurofibromatoses
Acoustic Neuroma
progressions
Deglutition
Hearing Loss
radiation therapy
margins
Prescriptions
Neck

Keywords

  • Jugular foramen
  • Radiosurgery
  • Schwannoma
  • Trigeminal

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Stereotactic radiosurgery : The preferred management for patients with nonvestibular schwannomas? / Pollock, Bruce E.; Foote, Robert L.; Stafford, Scott L.

In: International Journal of Radiation Oncology Biology Physics, Vol. 52, No. 4, 15.03.2002, p. 1002-1007.

Research output: Contribution to journalArticle

Pollock, Bruce E. ; Foote, Robert L. ; Stafford, Scott L. / Stereotactic radiosurgery : The preferred management for patients with nonvestibular schwannomas?. In: International Journal of Radiation Oncology Biology Physics. 2002 ; Vol. 52, No. 4. pp. 1002-1007.
@article{e6ad23636b0d4d6db94517cc5d223a3c,
title = "Stereotactic radiosurgery: The preferred management for patients with nonvestibular schwannomas?",
abstract = "Purpose: To review patient outcomes after radiosurgery of nonvestibular schwannomas. Methods and Materials: From April 1992 to February 2000, 23 patients had radiosurgery at our center for nonvestibular schwannomas. Affected cranial nerves included the trochlear (n = 1), trigeminal (n = 10), jugular foramen region (n = 10), and hypoglossal (n = 2). Nine patients had undergone one or more prior tumor resections. One patient had a malignant schwannoma; 2 patients had neurofibromatosis. The median prescription isodose volume was 8.9 cc (range, 0.2 to 17.6 cc). The median tumor margin dose was 18 Gy (range, 12 to 20 Gy); the median maximum dose was 36 Gy (range, 24 to 40 Gy). The median follow-up after radiosurgery was 43 months (range, 12 to 111 months). Results: Twenty-two of 23 tumors (96{\%}) were either smaller (n = 12) or unchanged in size (n = 10) after radiosurgery. One patient with a malignant schwannoma had tumor progression outside the irradiated volume despite having both radiosurgery and fractionated radiation therapy (50.4 Gy); he died 4 years later. Morbidity related to radiosurgery occurred in 4 patients (17{\%}). Three of 10 patients with trigeminal schwannomas suffered new or worsened trigeminal dysfunction after radiosurgery. One patient with a hypoglossal schwannoma had eustachian tube dysfunction after radiosurgery. No patient with a lower cranial nerve schwannoma developed any hearing loss, facial weakness, or swallowing difficulty after radiosurgery. Conclusions: Although the reported number of patients having radiosurgery for nonvestibular schwannomas is limited, the high tumor control rates demonstrated after vestibular schwannoma radiosurgery should apply to these rare tumors. Compared to historical controls treated with surgical resection, radiosurgery appears to have less treatment-associated morbidity for nonvestibular schwannomas, especially for schwannomas involving the lower cranial nerves.",
keywords = "Jugular foramen, Radiosurgery, Schwannoma, Trigeminal",
author = "Pollock, {Bruce E.} and Foote, {Robert L.} and Stafford, {Scott L.}",
year = "2002",
month = "3",
day = "15",
doi = "10.1016/S0360-3016(01)02711-0",
language = "English (US)",
volume = "52",
pages = "1002--1007",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Stereotactic radiosurgery

T2 - The preferred management for patients with nonvestibular schwannomas?

AU - Pollock, Bruce E.

AU - Foote, Robert L.

AU - Stafford, Scott L.

PY - 2002/3/15

Y1 - 2002/3/15

N2 - Purpose: To review patient outcomes after radiosurgery of nonvestibular schwannomas. Methods and Materials: From April 1992 to February 2000, 23 patients had radiosurgery at our center for nonvestibular schwannomas. Affected cranial nerves included the trochlear (n = 1), trigeminal (n = 10), jugular foramen region (n = 10), and hypoglossal (n = 2). Nine patients had undergone one or more prior tumor resections. One patient had a malignant schwannoma; 2 patients had neurofibromatosis. The median prescription isodose volume was 8.9 cc (range, 0.2 to 17.6 cc). The median tumor margin dose was 18 Gy (range, 12 to 20 Gy); the median maximum dose was 36 Gy (range, 24 to 40 Gy). The median follow-up after radiosurgery was 43 months (range, 12 to 111 months). Results: Twenty-two of 23 tumors (96%) were either smaller (n = 12) or unchanged in size (n = 10) after radiosurgery. One patient with a malignant schwannoma had tumor progression outside the irradiated volume despite having both radiosurgery and fractionated radiation therapy (50.4 Gy); he died 4 years later. Morbidity related to radiosurgery occurred in 4 patients (17%). Three of 10 patients with trigeminal schwannomas suffered new or worsened trigeminal dysfunction after radiosurgery. One patient with a hypoglossal schwannoma had eustachian tube dysfunction after radiosurgery. No patient with a lower cranial nerve schwannoma developed any hearing loss, facial weakness, or swallowing difficulty after radiosurgery. Conclusions: Although the reported number of patients having radiosurgery for nonvestibular schwannomas is limited, the high tumor control rates demonstrated after vestibular schwannoma radiosurgery should apply to these rare tumors. Compared to historical controls treated with surgical resection, radiosurgery appears to have less treatment-associated morbidity for nonvestibular schwannomas, especially for schwannomas involving the lower cranial nerves.

AB - Purpose: To review patient outcomes after radiosurgery of nonvestibular schwannomas. Methods and Materials: From April 1992 to February 2000, 23 patients had radiosurgery at our center for nonvestibular schwannomas. Affected cranial nerves included the trochlear (n = 1), trigeminal (n = 10), jugular foramen region (n = 10), and hypoglossal (n = 2). Nine patients had undergone one or more prior tumor resections. One patient had a malignant schwannoma; 2 patients had neurofibromatosis. The median prescription isodose volume was 8.9 cc (range, 0.2 to 17.6 cc). The median tumor margin dose was 18 Gy (range, 12 to 20 Gy); the median maximum dose was 36 Gy (range, 24 to 40 Gy). The median follow-up after radiosurgery was 43 months (range, 12 to 111 months). Results: Twenty-two of 23 tumors (96%) were either smaller (n = 12) or unchanged in size (n = 10) after radiosurgery. One patient with a malignant schwannoma had tumor progression outside the irradiated volume despite having both radiosurgery and fractionated radiation therapy (50.4 Gy); he died 4 years later. Morbidity related to radiosurgery occurred in 4 patients (17%). Three of 10 patients with trigeminal schwannomas suffered new or worsened trigeminal dysfunction after radiosurgery. One patient with a hypoglossal schwannoma had eustachian tube dysfunction after radiosurgery. No patient with a lower cranial nerve schwannoma developed any hearing loss, facial weakness, or swallowing difficulty after radiosurgery. Conclusions: Although the reported number of patients having radiosurgery for nonvestibular schwannomas is limited, the high tumor control rates demonstrated after vestibular schwannoma radiosurgery should apply to these rare tumors. Compared to historical controls treated with surgical resection, radiosurgery appears to have less treatment-associated morbidity for nonvestibular schwannomas, especially for schwannomas involving the lower cranial nerves.

KW - Jugular foramen

KW - Radiosurgery

KW - Schwannoma

KW - Trigeminal

UR - http://www.scopus.com/inward/record.url?scp=0037086352&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037086352&partnerID=8YFLogxK

U2 - 10.1016/S0360-3016(01)02711-0

DO - 10.1016/S0360-3016(01)02711-0

M3 - Article

C2 - 11958895

AN - SCOPUS:0037086352

VL - 52

SP - 1002

EP - 1007

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 4

ER -