Stereotactic radiosurgery found to be effective for treatment of vestibular schwannomas in neurofibromatosis type 2 (75% success at 15 years from one session)

Medical Xpress / Wolters Kluwer Health / Neurosurgery ^ | April 18, 2023 | Othman Bin-Alamer et al

[ConservativeMind]

Vestibular schwannomas related to neurofibromatosis type 2 (NF2) are difficult to manage and are sometimes treated with a noninvasive option, stereotactic radiosurgery. A retrospective study found that stereotactic radiosurgery is effective for patients with these tumors while preserving serviceable hearing and not causing radiation-related tumor development or malignant transformation.

NF2 is a genetic condition that results in the growth of tumors of the brain, spinal cord, and peripheral nerves. A vestibular schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) develops from the nerves of the inner ear that control balance and hearing.

Many people with NF2 develop vestibular schwannomas in both ears that are very difficult to manage, often requiring multiple surgeries and/or other procedures.

To better understand the effectiveness and safety of stereotactic radiosurgery for NF2-related vestibular schwannomas, Hussam Abou-Al-Shaar, MD and colleagues reviewed data on 267 patients (328 vestibular schwannomas) who underwent single-session stereotactic radiosurgery at 12 centers across the world.

The researchers report multiple positive outcomes:

Tumor control likelihood of 77% at 10 years and 52% at 15 years

Likelihood of not requiring additional treatment of 85% at 10 years and 75% at 15 years

Likelihood of preserving serviceable hearing of 64% at five years and 35% at 10 years

The only significant predictor of tumor progression was tumor volume, with each one cm3 increase in tumor volume increasing the relative risk of tumor progression by 8%. The tumor progression rate was 48% at 15 years after stereotactic radiosurgery, but only 25% of patients required additional treatment by that time point, suggesting that despite radiographic progression, only half merited treatment.

Dr. Abou-Al-Shaar and his colleagues report that during the median 59 months of follow-up, "We did not observe any event of radiation-induced tumor development or NF2-associated vestibular schwannoma malignant transformation."

[ConservativeMind]

Hearing loss at ten years did mean only 35% had “serviceable” hearing, but people still had great overall benefit from one session of radiation, which is beautiful.

[ConservativeMind]

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