Efficacy and comorbidities of hypofractionated and single-dose radiosurgery for vestibular schwannomas: a systematic review and meta-analysis.
acoustic neuromas
hypofractionated radiotherapy
radiosurgery
vestibular schwannomas
Journal
Neuro-oncology practice
ISSN: 2054-2577
Titre abrégé: Neurooncol Pract
Pays: England
ID NLM: 101640528
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
entrez:
19
7
2021
pubmed:
20
7
2021
medline:
20
7
2021
Statut:
epublish
Résumé
Vestibular schwannomas (VS) are tumors of the cerebellopontine angle with significant morbidity, causing hearing loss, tinnitus, and trigeminal and facial nerve compromise. An effective alternative to microsurgical resection is stereotactic radiosurgery (SRS), which can be delivered in either single-fraction (SRS) or hypofractionated stereotactic radiotherapy (hSRT) (3-5 treatments) regimens. It remains unclear which fractionation regimen provides superior outcomes. Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews were searched for studies either comparing hSRT with SRS or focusing on hSRT alone in treating VS. Primary endpoints included tumor control, serviceable hearing, tinnitus, and cranial nerve V and VII symptoms. A random-effects analysis was employed to compare pre- and post-treatment effects (hSRT alone) or SRS and hSRT outcomes (two-arm studies). This analysis included 21 studies focusing on hSRT alone and 13 studies comparing SRS and hSRT. Significant heterogeneity was observed. Overall, when hSRT was analyzed alone, crude tumor control was achieved in 94% (95% CI: 88%, 99%) of 1571 patients. There was no difference between pre- and post-treatment odds ratios (OR) of tinnitus, facial, or trigeminal impairment. Serviceable hearing was diminished following hSRT (OR = 0.60, 95% CI: 0.44, 0.83). Comparison with SRS showed no difference with respect to tumor control, serviceable hearing, trigeminal or facial nerve impairment. hSRT achieved excellent tumor control and, with the exception of serviceable hearing, did not result in worse post-treatment cranial nerve symptomatology. Analysis of comparative studies between hSRT and SRS did not reveal any significant difference in either tumor control or treatment morbidities.
Sections du résumé
BACKGROUND
BACKGROUND
Vestibular schwannomas (VS) are tumors of the cerebellopontine angle with significant morbidity, causing hearing loss, tinnitus, and trigeminal and facial nerve compromise. An effective alternative to microsurgical resection is stereotactic radiosurgery (SRS), which can be delivered in either single-fraction (SRS) or hypofractionated stereotactic radiotherapy (hSRT) (3-5 treatments) regimens. It remains unclear which fractionation regimen provides superior outcomes.
METHODS
METHODS
Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews were searched for studies either comparing hSRT with SRS or focusing on hSRT alone in treating VS. Primary endpoints included tumor control, serviceable hearing, tinnitus, and cranial nerve V and VII symptoms. A random-effects analysis was employed to compare pre- and post-treatment effects (hSRT alone) or SRS and hSRT outcomes (two-arm studies).
RESULTS
RESULTS
This analysis included 21 studies focusing on hSRT alone and 13 studies comparing SRS and hSRT. Significant heterogeneity was observed. Overall, when hSRT was analyzed alone, crude tumor control was achieved in 94% (95% CI: 88%, 99%) of 1571 patients. There was no difference between pre- and post-treatment odds ratios (OR) of tinnitus, facial, or trigeminal impairment. Serviceable hearing was diminished following hSRT (OR = 0.60, 95% CI: 0.44, 0.83). Comparison with SRS showed no difference with respect to tumor control, serviceable hearing, trigeminal or facial nerve impairment.
CONCLUSIONS
CONCLUSIONS
hSRT achieved excellent tumor control and, with the exception of serviceable hearing, did not result in worse post-treatment cranial nerve symptomatology. Analysis of comparative studies between hSRT and SRS did not reveal any significant difference in either tumor control or treatment morbidities.
Identifiants
pubmed: 34277018
doi: 10.1093/nop/npab009
pii: npab009
pmc: PMC8278347
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
391-404Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002384
Pays : United States
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Références
Strahlenther Onkol. 2014 Jun;190(6):533-7
pubmed: 24589920
Strahlenther Onkol. 2014 Sep;190(9):798-805
pubmed: 24638268
J Otol. 2017 Dec;12(4):174-184
pubmed: 29937853
J Neurosurg. 2005 Jul;103(1):59-63
pubmed: 16121974
Otol Neurotol. 2020 Jun;41(5):e529-e537
pubmed: 32150022
World Neurosurg. 2017 Feb;98:152-161
pubmed: 27777160
Eur Radiol. 2016 Mar;26(3):849-57
pubmed: 26139318
Cancers (Basel). 2019 Oct 07;11(10):
pubmed: 31591325
Acta Neurochir (Wien). 2017 Jun;159(6):1013-1021
pubmed: 28409393
Otol Neurotol. 2011 Feb;32(2):297-300
pubmed: 21192276
Otol Neurotol. 2006 Jun;27(4):547-52
pubmed: 16791048
Stereotact Funct Neurosurg. 1997;69(1-4 Pt 2):175-82
pubmed: 9711752
Front Oncol. 2013 May 17;3:121
pubmed: 23730624
J Neurooncol. 2014 Jan;116(1):187-93
pubmed: 24142200
Radiother Oncol. 2010 Apr;95(1):94-8
pubmed: 20138381
Ann Otol Rhinol Laryngol. 2015 Oct;124(10):834-40
pubmed: 26019282
Neurosurgery. 2019 Oct 1;85(4):550-559
pubmed: 30247723
J Radiat Res. 2014 Mar 1;55(2):351-8
pubmed: 24142966
Otol Neurotol. 2018 Feb;39(2):232-241
pubmed: 29315189
Biomed Res Int. 2014;2014:315952
pubmed: 24987677
J Neurosurg. 2018 Jul;129(1):137-145
pubmed: 28984523
Front Oncol. 2017 Sep 04;7:200
pubmed: 28929084
Otol Neurotol. 2011 Jan;32(1):125-31
pubmed: 21131891
J Neurol Surg B Skull Base. 2019 Apr;80(2):165-168
pubmed: 30931224
J Neurosurg. 2018 Jan;128(1):49-59
pubmed: 28128697
Int J Radiat Oncol Biol Phys. 1996 Sep 1;36(2):275-80
pubmed: 8892449
Singapore Med J. 2018 Nov;59(11):590-596
pubmed: 30182129
Otol Neurotol. 2020 Feb;41(2):e256-e261
pubmed: 31644476
Stereotact Funct Neurosurg. 1999;73(1-4):45-9
pubmed: 10853097
Acta Neurochir Suppl. 2008;101:169-73
pubmed: 18642654
Am J Otolaryngol. 2018 Sep - Oct;39(5):561-566
pubmed: 29961654
Rep Pract Oncol Radiother. 2016 Jul-Aug;21(4):399-406
pubmed: 27330427
Neurosurgery. 2008 May;62(5 Suppl):A37-42; discussion A42-3
pubmed: 18580779
J Neurosurg. 2015 Apr;122(4):818-24
pubmed: 25594321
J Neurooncol. 2011 May;103(1):1-17
pubmed: 21152953
Otol Neurotol. 2015 Sep;36(8):1301-8
pubmed: 26134937
Neuro Oncol. 2006 Jan;8(1):1-11
pubmed: 16443943
Neurosurgery. 2011 Dec;69(6):1200-9
pubmed: 21558974
Otol Neurotol. 2018 Mar;39(3):357-364
pubmed: 29342057
J Neurooncol. 2019 Nov;145(2):247-255
pubmed: 31535315
Neurosurgery. 2005 Jun;56(6):1254-61; discussion 1261-3
pubmed: 15918941
Otol Neurotol. 2020 Apr;41(4):530-536
pubmed: 32176144
Int J Clin Oncol. 2011 Feb;16(1):27-32
pubmed: 20830603
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e503-9
pubmed: 21665381
Auris Nasus Larynx. 2001 May;28 Suppl:S23-7
pubmed: 11683337
Neurosurg Rev. 2011 Jul;34(3):265-77; discussion 277-9
pubmed: 21305333
Neuro Oncol. 2020 Jan 11;22(1):31-45
pubmed: 31504802
Int J Radiat Oncol Biol Phys. 2002 Oct 1;54(2):500-4
pubmed: 12243828
Clin Neurol Neurosurg. 2020 Jun;193:105769
pubmed: 32146233
Acta Otorrinolaringol Esp. 2015 Jul-Aug;66(4):185-91
pubmed: 25497840
J Pak Med Assoc. 2016 Sep;66(9):1089-1093
pubmed: 27654726
Neurosurgery. 2014 Mar;74(3):292-300; discussion 300-1
pubmed: 24335819
Comput Aided Surg. 2011;16(3):112-20
pubmed: 21466421
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):647-53
pubmed: 20884130
Laryngoscope. 2005 Feb;115(2):292-6
pubmed: 15689753
Clin Neurol Neurosurg. 2018 Mar;166:116-123
pubmed: 29414150
Neuro Oncol. 2012 Jan;14(1):87-92
pubmed: 22028389
Radiother Oncol. 2009 Feb;90(2):208-12
pubmed: 19054586
Acta Neurochir (Wien). 2002 Dec;144(12):1249-54; discussion 1254
pubmed: 12478335
Otol Neurotol. 2018 Mar;39(3):273-283
pubmed: 29342035
Neurosurgery. 2018 Jul 1;83(1):38-42
pubmed: 28973692
J Clin Neurosci. 2003 Jan;10(1):48-52
pubmed: 12464521
Otol Neurotol. 2015 Apr;36(4):638-46
pubmed: 25415463
AJNR Am J Neuroradiol. 2008 May;29(5):906-10
pubmed: 18296549
Otol Neurotol. 2020 Jun;41(5):679-685
pubmed: 32150025
Int J Clin Oncol. 2018 Aug;23(4):608-614
pubmed: 29556918
Int J Radiat Oncol Biol Phys. 2003 Aug 1;56(5):1390-6
pubmed: 12873685
J Med Genet. 2006 Apr;43(4):289-94
pubmed: 16155191
World Neurosurg. 2016 Sep;93:398-409
pubmed: 27368508
World Neurosurg. 2019 Sep;129:e303-e310
pubmed: 31132496
Neurosurg Focus. 2012 Sep;33(3):E8
pubmed: 22937859