Stereotactic radiotherapy for trigeminal schwannomas.

Abstract

BACKGROUND:

Data on radiotherapy for trigeminal schwannomas (TSs) and comparison of stereotactic radiosurgery (SRS) with fractionated stereotactic radiotherapy (FSRT) are limited.

OBJECTIVE:

We present a large retrospective review of our institutional experience treating TSs with SRS and FSRT. We also describe a flare phenomenon experienced by some patients.

METHODS:

The records of 23 consecutive TSs patients treated with radiotherapy between 1996 and 2011 were reviewed. We investigated radiographic response, tumor control, and toxicity.

RESULTS:

Ten patients underwent SRS and 13 underwent FSRT, with median clinical follow-up of 32 months (range, 3-120 months). Tumor control at 5 and 10 years was 94% overall. Symptom control at 5 years was achieved in 48% of all patients, with nonsignificant improvement in more patients in the FSRT group than those in the SRS group (56% vs 40%, P = .37). Acute toxicity was higher in the FSRT group (38.5 vs 0%, P < .01), although lesions treated with FSRT were larger (mean, 9.5 mL vs 4.8 mL, P < .01). A symptomatic flare phenomenon occurred in 2 patients (8.7% overall) during FSRT, involving transient cystic formation and dramatic size increase. One lesion regressed in size and 1 remained stable on follow-up.

CONCLUSION:

Tumor control rates for TSs are excellent with SRS and FSRT with minimal toxicity. This represents the first documented report of a flare phenomenon after FSRT for TS treatment. Flare risk after FSRT in previously resected large lesions should be discussed with patients before treatment, and prophylactic oral steroids may be considered.

• Authors: Colin E Champ, Mark V Mishra, Wenyin Shi, Joshua Siglin, Maria Werner-Wasik, David W Andrews, James J Evans
• Journal: Neurosurgery (Neurosurgery) Vol. 71 Issue 2 Pg. 270-7; discussion 277 (Aug 2012) ISSN: 1524-4040 [Electronic] United States
• PMID: 22472550 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cranial Nerve Neoplasms (surgery)
• Female
• Humans
• Male
• Middle Aged
• Neurilemmoma (surgery)
• Radiosurgery (methods)
• Treatment Outcome
• Trigeminal Nerve Diseases (surgery)