Stereotactic Radiosurgery for Vestibular Schwannoma — A Case-Based Practice Guide From the Radiosurgery Society

IF 3.5 3区医学 Q2 ONCOLOGY Practical Radiation Oncology Pub Date : 2025-07-01 Epub Date: 2025-02-03 DOI:10.1016/j.prro.2025.01.010

Felix Ehret MD , Archis R. Bhandarkar MD, MS , Michael Chisam MD , Victor Goulenko MD , Ritesh Kumar MD , Fatemeh Fekrmandi MD, MS , Karin A. Skalina MD, PhD , John Kresl MD, PhD , Simon S. Lo MD , Iris C. Gibbs MD , Scott G. Soltys MD , Jason P. Sheehan MD, PhD , Christoph Fürweger PhD , Ben J. Slotman MD, PhD , Helen A. Shih MD, MS, MPH , Samuel T. Chao MD

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Abstract

Purpose

Vestibular schwannomas (VS) are the most common benign intracranial nerve sheath tumors. Surgery and radiation therapy – particularly stereotactic radiosurgery (SRS) – are the primary treatment options. SRS is the dominant treatment for small- and medium-sized VS and selected larger tumors due to its excellent local control rates and favorable safety profile compared with surgery. However, careful treatment planning is essential, taking into account patient preferences, tumor location and size, symptoms, and anticipated treatment-related toxicity.

Methods and Materials

Four clinical VS scenarios have been selected to illustrate the use of SRS, including a unilateral small intracanalicular VS, a large VS with cystic components, reirradiation with SRS after local tumor recurrence, and bilateral VS in the setting of neurofibromatosis type 2-related schwannomatosis.

Results

SRS is an effective and safe treatment modality for the majority of VS cases, requiring careful treatment planning and a thorough understanding of potential limitations and challenges.

Conclusions

This case-based practice guide aims to provide a concise overview of the treatment of VS with SRS. We present and discuss 4 different clinical scenarios of VS to highlight the pitfalls and best practice recommendations.

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立体定向放射外科治疗前庭神经鞘瘤-放射外科学会基于病例的实践指南。

目的：前庭神经鞘瘤（Vestibular schwannomas， VS）是颅内最常见的良性神经鞘肿瘤。手术和放疗——尤其是立体定向放射外科（SRS）——是主要的治疗选择。与手术相比，SRS具有良好的局部控制率和良好的安全性，是中小型VS和部分较大肿瘤的主要治疗方法。然而，仔细的治疗计划是必要的，要考虑到患者的偏好、肿瘤的位置和大小、症状和预期的治疗相关毒性。方法和材料：选择了四种临床VS情况来说明SRS的使用，包括单侧小管内VS，带有囊性成分的大VS，局部肿瘤复发后再照射SRS，以及2型神经纤维瘤病相关神经鞘瘤病的双侧VS。结果：对于大多数VS病例，SRS是一种有效且安全的治疗方式，但需要仔细的治疗计划，并充分了解潜在的局限性和挑战。结论：本案例为基础的实践指南旨在提供使用SRS治疗VS的简明概述。我们提出并讨论了四种不同的VS临床情况，以说明陷阱和最佳实践建议。

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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.