Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system

Abstract Stereotactic radiosurgery (SRS) has evolved as widely accepted treatment option for small-sized (Koos I up to II) vestibular schwannoma (VS). For larger tumors (prevalent Koos VI), microsurgery or combined treatment strategies are mostly recommended. However, in patients not suited for micr...

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Autores principales:	Daniel Rueß, Lea Pöhlmann, Stefan Grau, Christina Hamisch, Mauritius Hoevels, Harald Treuer, Christian Baues, Martin Kocher, Maximillian Ruge
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Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1129e41c4c7444cfbe7f09cc4649a685
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spelling	oai:doaj.org-article:1129e41c4c7444cfbe7f09cc4649a6852021-12-02T17:52:42ZOutcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system10.1038/s41598-020-66213-42045-2322https://doaj.org/article/1129e41c4c7444cfbe7f09cc4649a6852020-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-66213-4https://doaj.org/toc/2045-2322Abstract Stereotactic radiosurgery (SRS) has evolved as widely accepted treatment option for small-sized (Koos I up to II) vestibular schwannoma (VS). For larger tumors (prevalent Koos VI), microsurgery or combined treatment strategies are mostly recommended. However, in patients not suited for microsurgery, SRS might also be an alternative to balance tumor control, hearing preservation and adverse effects. The purpose of this analysis was to evaluate the efficacy and toxicity of SRS for VS with regard to different Koos grades. All patients with untreated VS who received SRS at our center were included. Outcome analysis included tumor control, preservation of serviceable hearing based on median pure tone averages (PTA), and procedure-related adverse events rated by the Common Terminology Criteria for Adverse Events (CTCAE; v4.03) classification. In total, 258 patients (median age 58 years, range 21–84) were identified with a mean follow-up of 52 months (range 3–228 months). Mean tumor volume was 1.8 ml (range 0.1–18.5). The mean marginal dose was 12.3 Gy ± 0.6 (range 11–13.5). The cohort was divided into two groups: A (Koos grades I and II, n = 186) and B (Koos grades III and IV, n = 72). The actuarial tumor control rate was 98% after 2 years and 90% after 5 and 10 years. Koos grading did not show a significant impact on tumor control (p = 0.632) or hearing preservation (p = 0.231). After SRS, 18 patients (7%) had new transient or permanent symptoms classified by the CTCAE. The actuarial rate of CTCAE-free survival was not related to Koos grading (p = 0.093). Based on this selected population of Koos grade III and IV VS without or with only mild symptoms from brainstem compression, SRS can be recommended as the primary therapy with the advantage of low morbidity and satisfactory tumor control. The overall hearing preservation rate and toxicity of SRS was influenced by age and cannot be predicted by tumor volume or Koos grading alone.Daniel RueßLea PöhlmannStefan GrauChristina HamischMauritius HoevelsHarald TreuerChristian BauesMartin KocherMaximillian RugeNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-9 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Daniel Rueß Lea Pöhlmann Stefan Grau Christina Hamisch Mauritius Hoevels Harald Treuer Christian Baues Martin Kocher Maximillian Ruge Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system
description	Abstract Stereotactic radiosurgery (SRS) has evolved as widely accepted treatment option for small-sized (Koos I up to II) vestibular schwannoma (VS). For larger tumors (prevalent Koos VI), microsurgery or combined treatment strategies are mostly recommended. However, in patients not suited for microsurgery, SRS might also be an alternative to balance tumor control, hearing preservation and adverse effects. The purpose of this analysis was to evaluate the efficacy and toxicity of SRS for VS with regard to different Koos grades. All patients with untreated VS who received SRS at our center were included. Outcome analysis included tumor control, preservation of serviceable hearing based on median pure tone averages (PTA), and procedure-related adverse events rated by the Common Terminology Criteria for Adverse Events (CTCAE; v4.03) classification. In total, 258 patients (median age 58 years, range 21–84) were identified with a mean follow-up of 52 months (range 3–228 months). Mean tumor volume was 1.8 ml (range 0.1–18.5). The mean marginal dose was 12.3 Gy ± 0.6 (range 11–13.5). The cohort was divided into two groups: A (Koos grades I and II, n = 186) and B (Koos grades III and IV, n = 72). The actuarial tumor control rate was 98% after 2 years and 90% after 5 and 10 years. Koos grading did not show a significant impact on tumor control (p = 0.632) or hearing preservation (p = 0.231). After SRS, 18 patients (7%) had new transient or permanent symptoms classified by the CTCAE. The actuarial rate of CTCAE-free survival was not related to Koos grading (p = 0.093). Based on this selected population of Koos grade III and IV VS without or with only mild symptoms from brainstem compression, SRS can be recommended as the primary therapy with the advantage of low morbidity and satisfactory tumor control. The overall hearing preservation rate and toxicity of SRS was influenced by age and cannot be predicted by tumor volume or Koos grading alone.
format	article
author	Daniel Rueß Lea Pöhlmann Stefan Grau Christina Hamisch Mauritius Hoevels Harald Treuer Christian Baues Martin Kocher Maximillian Ruge
author_facet	Daniel Rueß Lea Pöhlmann Stefan Grau Christina Hamisch Mauritius Hoevels Harald Treuer Christian Baues Martin Kocher Maximillian Ruge
author_sort	Daniel Rueß
title	Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system
title_short	Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system
title_full	Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system
title_fullStr	Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system
title_full_unstemmed	Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system
title_sort	outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the koos grading system
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/1129e41c4c7444cfbe7f09cc4649a685
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Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system

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