TY - JOUR
T1 - Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery
T2 - Results From a Multicenter, International Cohort Study
AU - Niranjan, Ajay
AU - Faramand, Andrew
AU - Raju, Sudesh S.
AU - Lee, Cheng Chia
AU - Yang, Huai Che
AU - Nabeel, Ahmed M.
AU - Tawadros, Sameh R.
AU - El-Shehaby, Amr M.N.
AU - Abdelkarim, Khaled
AU - Emad, Reem M.
AU - Reda, Wael A.
AU - Álvarez, Roberto Martínez
AU - Moreno, Nuria E.Martínez
AU - Liscak, Roman
AU - May, Jaromir
AU - Mathieu, David
AU - Langlois, Anne Marie
AU - Snyder, M. Harrison
AU - Shepard, Matthew J.
AU - Sheehan, Jason
AU - Muhsen, Baha'eddin A.
AU - Borghei-Razavi, Hamid
AU - Barnett, Gene
AU - Kondziolka, Douglas
AU - Golfinos, John G.
AU - Attuati, Luca
AU - Picozzi, Piero
AU - McInerney, James
AU - Daggubati, Lekhaj Chand
AU - Warnick, Ronald E.
AU - Feliciano, Caleb E.
AU - Carro, Eric
AU - McCarthy, David
AU - Starke, Robert M.
AU - Landy, Howard J.
AU - Cifarelli, Christopher P.
AU - Vargo, John A.
AU - Flickinger, John
AU - Lunsford, L. Dade
N1 - Publisher Copyright:
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - BACKGROUND AND OBJECTIVES: An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS: Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. RESULTS: The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). CONCLUSION: SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
AB - BACKGROUND AND OBJECTIVES: An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. METHODS: Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. RESULTS: The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival ( P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS ( P = .003) and smaller tumor volume ( P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). CONCLUSION: SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
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U2 - 10.1227/neu.0000000000002623
DO - 10.1227/neu.0000000000002623
M3 - Article
C2 - 37523519
AN - SCOPUS:85179842283
SN - 0148-396X
VL - 94
SP - 165
EP - 173
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -