THE OUTCOMES OF FRACTIONATED CYBER KNIFE STEREOTACTIC RADIOSURGERY FOR VESTIBULAR SCHWANNOMAS

Marya Hameed, Sumera Mahar, Naveed Ahmed, Tariq Mahmood

Abstract


Introduction: Vestibular Schwannomas causes significant morbidity and quality of life can be effected in major way if not promptly managed. There are various therapeutic options available to cure the disease but cyber knife stereotactic radiosurgery is one of leading therapeutic option to manage vestibular schwannomas with minimal to no complications.

Objective: Use of fractionated stereotactic radiosurgery / radiotherapy, specifically cyber knife device in patients with vestibular schwannomas to evaluate tumor control, hearing preservation status and complication ratios.

Methods:  Data was collected comprising of patients with vestibular schwannomas who have been treated with stereotactic radiosurgery/radiotherapy from Dec 2018 to April 2021 at Jinnah postgraduate medical center Karachi. The methods consisted of a prospective study in which the patients were subjected to a dose ranging from 12 to 18 Gy with an average of   three fractions by using cyber knife system. P<0.05 was taken into significant consideration.

Results: 130(56.52%) were women and 100(43.47%) were men, among 230 cases. After stereotactic radiosurgery/radiotherapy the median follow-up duration was 24 months (interquartile range: 10-42 months). With the median follow-up of three years the radiographic control evaluation ratio was 95.7% (IQR: 18.5 months). Among 230 patients, results of 129(56%) patients showed stabile response, 98(42%) showed improving response and three (1.3%) showed worsening response. However there were no statistically significant changes between pre and post treatment symptoms (p>0.05). New onset facial paresis was noted in two (1%) patients.

Conclusion: The outcome of treatment of vestibular schwannomas by using stereotactic radiosurgery resulted in good ratio of tumor control. Ratios of toxicity and hearing preservation status were approximate to the published literature.

Keywords: vestibular schwannomas, cyber knife, stereotactic radiosurgery/radiotherapy.


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References


Tsai T, Lin JW, Lin CM, Chen YH, Ma HI, Jen YM, et al. Clinical Evaluation of Cyber Knife in the Treatment of Vestibular Schwannomas. Bio Med Res Int 2013; 2013: 1-6.

Lassaletta L, Gavilan J. An update on the treatment of vestibular schwannoma. Acta Otorrinolaringol Esp 2009; 60: 131-40.

Propp JM, McCarthy BJ, Davis FG, Martin SP. Descriptive epidemiology of vestibular schwannomas. Neuro Oncol 2006; 8: 1-11.

Karam SD, Tai A, Strohl A, Steehler MK, Rashid A, Gagnon G, et al. Frameless fractionated stereotactic radiosurgery for vestibular schwannomas: a single-institution experience. Front Oncol 2013; 3: 121.

Stucken EZ, Brown K, Selesnick S H. Clinical and diagnostic evaluation of acoustic neuro-mas.Otolaryngol. Clin North Am 2012; 45: 269-84.

Dutta D, Subramanian SB, Murli V, Sudahar H, Gopalakrishna Kurup PG, Potharaju M. Dosimetric comparison of Linac-based (BrainLAB) and robotic radio-surgery (CyberKnife) stereotactic system plans for acoustic schwannoma. J Neuro Oncol 2012; 106: 637-42.

Quesnel AM, McKenna MJ. Current strategies in management of intracanalicular vestibular schwannoma. Curr Opin Otolaryngol Head Neck Surg 2011; 19: 335-40.

Williams JA. Fractionated stereotactic radiotherapy for acoustic neuromas: reservation of function versus size. J Clin Neurosci 2003; 10: 48-52.

Leksell L. A note on the treatment of acoustic tumors. Acta Chir Scand 1971; 137: 763-5.

Ekici K, Ozseker N, Mayadagli A, Erdogan Kocak M, Olmezoglu A. Efficacy of stereotactic radiotherapy as salvage treatment for recurrent malignant gliomas. J BUON 2014; 19: 1029-34.

House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93: 146-7.

Arriaga MA, Luxford WM, Atkins JS, Kwartler JA. Predicting long-term facial nerve outcome after acoustic neuroma surgery. Otolaryngol Head Neck Surg 1993; 108: 220-4. 13.Gormley WB, Sekhar LN, Wright DC, Kamerer D, Schessel D. Acoustic neuromas: results of current surgical management. Neurosurgery 1997; 41: 50-8.

Sterkers JM, Morrison GA, Sterkers O, El-Dine MM. Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment. Otolaryngol Head Neck Surg 1994; 110: 146-55.

Dornhoffer JL, Helms J, Hoehmann DH. Hearing preservation in acoustic tumor surgery: results and prognostic factors. Laryngoscope 1995; 105: 4-187.

Kim CH, Chung KW, Kong DS, Nam DH, Park K, Kim JH, et al. Prognostic factors of hearing preservation after gamma knife radiosurgery for vestibular schwannoma. J Clini Neurosci 2010; 17: 214-8.

Franzin A, Spatola G, Serra C, Picozzi P, Medone M, Milani D, et al. Evaluation of hearingfunction after gamma knife surgery of vestibular schwannomas. Neurosurg Focus 2009; 27: E3.

Arthurs BJ, Fairbanks RK, Demakas JJ, Lamoreaux WT, Giddings NA, Mackay AR, et al. A review of treatment modalities for vestibular schwannoma. Neurosurg Rev 2011; 34: 265-77.

Ishihara H, Saito K, Nishizaki T, Kajiwara K, Nomura S, Yoshikawa K, et al. CyberKnife radiosurgery for vestibular schwannoma. Minim. Invasive Neurosurg 2004; 47: 290-3.

Murphy ES, Suh JH. Radiotherapy for vestibular schwannomas: a critical review. Int J Radiat Oncol Biol Phys 2011; 79: 985-97.

Karpinos M, Teh BS, Zeck O, Carpenter LS, Phan C, Mai WY, et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 2002; 54


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