Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery

PurposeIn this benign tumor entity, preservation of cranial nerve function is of special importance. Due to its advantageous physical properties, proton beam radiotherapy (PRT) is a promising approach that spares healthy tissue. Could PRT go along with satisfactory preservation rates for cranial ner...

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Autores principales:	Tanja Eichkorn, Sebastian Regnery, Thomas Held, Dorothea Kronsteiner, Juliane Hörner-Rieber, Rami A. El Shafie, Klaus Herfarth, Jürgen Debus, Laila König
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	acoustic neuroma vestibular schwannoma radiation-induced contrast enhancements (RICE) pseudoprogression radiation necrosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/e4ee6d2db9824cc29134a34b99469878
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spelling	oai:doaj.org-article:e4ee6d2db9824cc29134a34b994698782021-11-17T06:06:45ZEffectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery2234-943X10.3389/fonc.2021.772831https://doaj.org/article/e4ee6d2db9824cc29134a34b994698782021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.772831/fullhttps://doaj.org/toc/2234-943XPurposeIn this benign tumor entity, preservation of cranial nerve function is of special importance. Due to its advantageous physical properties, proton beam radiotherapy (PRT) is a promising approach that spares healthy tissue. Could PRT go along with satisfactory preservation rates for cranial nerve function without compromising tumor control in patients with cranial nerve schwannoma unsuitable for stereotactic radiosurgery?MethodsWe analyzed 45 patients with cranial nerve schwannomas who underwent PRT between 2012 and 2020 at our institution. Response assessment was performed by MRI according to RECIST 1.1, and toxicity was graded following CTCAE 5.0.ResultsThe most common schwannoma origin was the vestibulocochlear nerve with 82.2%, followed by the trigeminal nerve with 8.9% and the glossopharyngeal nerve as well as the vagal nerve, both with each 4.4%. At radiotherapy start, 58% of cranial nerve schwannomas were progressive and 95.6% were symptomatic. Patients were treated with a median total dose of 54 Gy RBE in 1.8 Gy RBE per fraction. MRI during the median follow-up period of 42 months (IQR 26–61) revealed stable disease in 93.3% of the patients and partial regression in 6.7%. There was no case of progressive disease. New or worsening cranial nerve dysfunction was found in 20.0% of all patients, but always graded as CTCAE °I-II. In seven cases (16%), radiation-induced contrast enhancements (RICE) were detected after a median time of 14 months (range 2–26 months). RICE were asymptomatic (71%) or transient symptomatic (CTCAE °II; 29%). No CTCAE °III/IV toxicities were observed. Lesions regressed during the follow-up period in three of the seven cases, and no lesion progressed during the follow-up period.ConclusionThese data demonstrate excellent effectiveness with 100% local control in a median follow-up period of 3.6 years with a promising cranial nerve functional protection rate of 80%. RICE occurred in 16% of the patients after PRT and were not or only mildly symptomatic.Tanja EichkornTanja EichkornSebastian RegnerySebastian RegneryThomas HeldThomas HeldDorothea KronsteinerJuliane Hörner-RieberJuliane Hörner-RieberRami A. El ShafieRami A. El ShafieKlaus HerfarthKlaus HerfarthJürgen DebusJürgen DebusJürgen DebusJürgen DebusJürgen DebusLaila KönigLaila KönigFrontiers Media S.A.articleacoustic neuromavestibular schwannomaradiation-induced contrast enhancements (RICE)pseudoprogressionradiation necrosisNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acoustic neuroma vestibular schwannoma radiation-induced contrast enhancements (RICE) pseudoprogression radiation necrosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	acoustic neuroma vestibular schwannoma radiation-induced contrast enhancements (RICE) pseudoprogression radiation necrosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Tanja Eichkorn Tanja Eichkorn Sebastian Regnery Sebastian Regnery Thomas Held Thomas Held Dorothea Kronsteiner Juliane Hörner-Rieber Juliane Hörner-Rieber Rami A. El Shafie Rami A. El Shafie Klaus Herfarth Klaus Herfarth Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Laila König Laila König Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery
description	PurposeIn this benign tumor entity, preservation of cranial nerve function is of special importance. Due to its advantageous physical properties, proton beam radiotherapy (PRT) is a promising approach that spares healthy tissue. Could PRT go along with satisfactory preservation rates for cranial nerve function without compromising tumor control in patients with cranial nerve schwannoma unsuitable for stereotactic radiosurgery?MethodsWe analyzed 45 patients with cranial nerve schwannomas who underwent PRT between 2012 and 2020 at our institution. Response assessment was performed by MRI according to RECIST 1.1, and toxicity was graded following CTCAE 5.0.ResultsThe most common schwannoma origin was the vestibulocochlear nerve with 82.2%, followed by the trigeminal nerve with 8.9% and the glossopharyngeal nerve as well as the vagal nerve, both with each 4.4%. At radiotherapy start, 58% of cranial nerve schwannomas were progressive and 95.6% were symptomatic. Patients were treated with a median total dose of 54 Gy RBE in 1.8 Gy RBE per fraction. MRI during the median follow-up period of 42 months (IQR 26–61) revealed stable disease in 93.3% of the patients and partial regression in 6.7%. There was no case of progressive disease. New or worsening cranial nerve dysfunction was found in 20.0% of all patients, but always graded as CTCAE °I-II. In seven cases (16%), radiation-induced contrast enhancements (RICE) were detected after a median time of 14 months (range 2–26 months). RICE were asymptomatic (71%) or transient symptomatic (CTCAE °II; 29%). No CTCAE °III/IV toxicities were observed. Lesions regressed during the follow-up period in three of the seven cases, and no lesion progressed during the follow-up period.ConclusionThese data demonstrate excellent effectiveness with 100% local control in a median follow-up period of 3.6 years with a promising cranial nerve functional protection rate of 80%. RICE occurred in 16% of the patients after PRT and were not or only mildly symptomatic.
format	article
author	Tanja Eichkorn Tanja Eichkorn Sebastian Regnery Sebastian Regnery Thomas Held Thomas Held Dorothea Kronsteiner Juliane Hörner-Rieber Juliane Hörner-Rieber Rami A. El Shafie Rami A. El Shafie Klaus Herfarth Klaus Herfarth Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Laila König Laila König
author_facet	Tanja Eichkorn Tanja Eichkorn Sebastian Regnery Sebastian Regnery Thomas Held Thomas Held Dorothea Kronsteiner Juliane Hörner-Rieber Juliane Hörner-Rieber Rami A. El Shafie Rami A. El Shafie Klaus Herfarth Klaus Herfarth Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Laila König Laila König
author_sort	Tanja Eichkorn
title	Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery
title_short	Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery
title_full	Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery
title_fullStr	Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery
title_full_unstemmed	Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery
title_sort	effectiveness and toxicity of fractionated proton beam radiotherapy for cranial nerve schwannoma unsuitable for stereotactic radiosurgery
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e4ee6d2db9824cc29134a34b99469878
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Effectiveness and Toxicity of Fractionated Proton Beam Radiotherapy for Cranial Nerve Schwannoma Unsuitable for Stereotactic Radiosurgery

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