Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study.

Journal

Neurosurgery

ISSN: 1524-4040

Titre abrégé: Neurosurgery

Pays: United States

ID NLM: 7802914

Informations de publication

Date de publication:
31 Jul 2023

Historique:

received: 03 01 2023

accepted: 19 05 2023

medline: 31 7 2023

pubmed: 31 7 2023

entrez: 31 7 2023

Statut: aheadofprint

Résumé

An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed. The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival (P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS (P = .003) and smaller tumor volume (P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%). SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE

An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma.

METHODS METHODS

Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years). Sixty patients (19%) had prior resections. Abnormal facial sensation was the commonest complaint (49%). The anatomic locations were root (N = 40), ganglion (N = 141), or dumbbell type (N = 128). The median tumor volume was 4 cc (range, 0.2-30.1 cc), and median margin dose was 13 Gy (range, 10-20 Gy). Factors associated with tumor control, symptom improvement, and adverse radiation events were assessed.

RESULTS RESULTS

The median and mean time to last follow-up was 49 and 65 months (range 6-242 months). Greater than 5-year follow-up was available for 139 patients (45%), and 50 patients (16%) had longer than 10-year follow-up. The overall tumor control rate was 94.5%. Tumors regressed in 146 patients (47.2%), remained unchanged in 128 patients (41.4%), and stabilized after initial expansion in 20 patients (6.5%). Progression-free survival rates at 3 years, 5 years, and 10 years were 91%, 86%, and 80 %. Smaller tumor volume (less than 8 cc) was associated with significantly better progression-free survival (P = .02). Seventeen patients with sustained growth underwent further intervention at a median of 27 months (3-144 months). Symptom improvement was noted in 140 patients (45%) at a median of 7 months. In multivariate analysis primary, SRS (P = .003) and smaller tumor volume (P = .01) were associated with better symptom improvement. Adverse radiation events were documented in 29 patients (9%).

CONCLUSION CONCLUSIONS

SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.

Identifiants

DOI: 10.1227/neu.0000000000002623 PMID: 37523519

pubmed: 37523519

doi: 10.1227/neu.0000000000002623

pii: 00006123-990000000-00836

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

Kano H, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for trigeminal schwannoma: tumor control and functional preservation Clinical article. J Neurosurg. 2009;110(3):553-558.

Barnett S, Anand V, Agazzi S, Niranjan A. Multimodality management of trigeminal schwannomas. J Neurol Surg B Skull Base. 2016;77(04):371-378.

Chen LF, Yang Y, Yu XG, et al. Operative management of trigeminal neuromas: an analysis of a surgical experience with 55 cases. Acta Neurochir (Wien). 2014;156(6):1105-1114.

Fukaya R, Yoshida K, Ohira T, Kawase T. Trigeminal schwannomas: experience with 57 cases and a review of the literature. Neurosurg Rev. 2010;34(2):159-171.

Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery. 2003;52(4):783-790;discussion 790.

Jeong SK, Lee EJ, Hue YH, Cho YH, Kim JH, Kim CJ. A suggestion of modified classification of trigeminal schwannomas according to location, shape, and extension. Brain Tumor Res Treat. 2014;2(2):62-68.

Konovalov AN, Spallone A, Mukhamedjanov DJ, Tcherekajev VA, Makhmudov UB. Trigeminal neurinomas. A series of 111 surgical cases from a single institution. Acta Neurochir (Wien). 1996;138(9):1027-1035.

McCormick PC, Bello JA, Post KD. Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. J Neurosurg. 1988;69(6):850-860.

Pamir MN, Peker S, Bayrakli F, Kilic T, Ozek MM. Surgical treatment of trigeminal schwannomas. Neurosurg Rev. 2007;30(4):329-337;discussion 337.

Pollack IF, Sekhar LN, Jannetta PJ, Janecka IP. Neurilemomas of the trigeminal nerves. J Neurosurg. 1989;70(5):737-745.

Samii M, Alimohamadi M, Gerganov V. Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminal schwannomas. Oper Neurosurg. 2014;10(4):565-575;discussion 575.

Wanibuchi M, Fukushima T, Zomordi AR, Nonaka Y, Friedman AH. Trigeminal schwannomas: skull base approaches and operative results in 105 patients. Oper Neurosurg. 2012;70(1 Suppl Operative):132-143;discussion 143-134.

Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg. 1999;91(2):202-211.

Hasegawa T, Kato T, Iizuka H, Kida Y. Long-term results for trigeminal schwannomas treated with gamma knife surgery. Int J Radiat Oncol Biol Phys. 2013;87(5):1115-1121.

Hasegawa T, Kida Y, Yoshimoto M, Koike J. Trigeminal schwannomas: results of gamma knife surgery in 37 cases. J Neurosurg. 2007;106(1):18-23.

Huang CF, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for trigeminal schwannomas. Neurosurgery. 1999;45(1):11-15;discussion 16.

Nettel B, Niranjan A, Martin JJ, et al. Gamma knife radiosurgery for trigeminal schwannomas. Surg Neurol. 2004;62(5):435-444;discussion 444-436.

Pan L, Wang EM, Zhang N, et al. Long-term results of Leksell gamma knife surgery for trigeminal schwannomas. J Neurosurg. 2005;102(Suppl):220-224.

Peker S, Bayrakli F, Kilic T, Pamir MN. Gamma-knife radiosurgery in the treatment of trigeminal schwannomas. Acta Neurochir (Wien). 2007;149(11):1133-1137;discussion 1137.

Phi JH, Paek SH, Chung HT, et al. Gamma Knife surgery and trigeminal schwannoma: is it possible to preserve cranial nerve function? J Neurosurg. 2007;107(4):727-732.

Sheehan J, Yen CP, Arkha Y, Schlesinger D, Steiner L. Gamma knife surgery for trigeminal schwannoma. J Neurosurg. 2007;106(5):839-845.

Sun J, Zhang J, Yu X, et al. Stereotactic radiosurgery for trigeminal schwannoma: a clinical retrospective study in 52 cases. Stereotact Funct Neurosurg. 2013;91(4):236-242.

Sun S, Liu A, Wang C, Luo B, Wang M. Clinical analysis of Gamma Knife surgery for trigeminal schwannomas. J Neurosurg. 2006;105(Supplement):144-148.

Yianni J, Dinca EB, Rowe J, Radatz M, Kemeny AA. Stereotactic radiosurgery for trigeminal schwannomas. Acta Neurochir (Wien). 2012;154(2):277-283.

Niranjan A, Raju SS, Kano H, Flickinger JC, Lunsford LD. Clinical and imaging response to trigeminal schwannoma radiosurgery: a retrospective analysis of a 28-year experience. J Neurol Surg B Skull Base. 2021;82(05):491-499.

Snyder MH, Shepard MJ, Chen CJ, Sheehan JP. Stereotactic radiosurgery for trigeminal schwannomas: a 28-year single-center experience and review of the literature. World Neurosurg. 2018;119:e874-e881.

Ryu J, Lee SH, Choi SK, Lim YJ. Gamma knife radiosurgery for trigeminal schwannoma: a 20-year experience with long-term treatment outcome. J Neurooncol. 2018;140(1):89-97.