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Repeat Gamma Knife surgery for vestibular schwannomas.

Lonneville S, Delbrouck C, Renier C, Devriendt D, Massager N - Surg Neurol Int (2015)

Bottom Line: Four patients had PET during follow-up, and all showed a significant metabolic decrease of the tumor.New facial or trigeminal palsy did not occur after retreatment.Our results support the long-term efficacy and low morbidity of repeat GK treatment for selected patients with tumor growth after initial treatment.

View Article: PubMed Central - PubMed

Affiliation: Gamma Knife Center, Hôpital Erasme, 1070 Brussels, Belgium ; Department of Neurosurgery, Hôpital Erasme, 1070 Brussels, Belgium.

ABSTRACT

Background: Gamma Knife (GK) surgery is a recognized treatment option for the management of small to medium-sized vestibular schwannoma (VS) associated with high-tumor control and low morbidity. When a radiosurgical treatment fails to stop tumor growth, repeat GK surgery can be proposed in selected cases.

Methods: A series of 27 GK retreatments was performed in 25 patients with VS; 2 patients underwent three procedures. The median time interval between GK treatments was 45 months. The median margin dose used for the first, second, and third GK treatments was 12 Gy, 12 Gy, and 14 Gy, respectively. Six patients (4 patients for the second irradiation and 2 patients for the third irradiation) with partial tumor regrowth were treated only on the growing part of the tumor using a median margin dose of 13 Gy. The median tumor volume was 0.9, 2.3, and 0.7 cc for the first, second, and third treatments, respectively. Stereotactic positron emission tomography (PET) guidance was used for dose planning in 6 cases.

Results: Mean follow-up duration was 46 months (range 24-110). At the last follow-up, 85% of schwannomas were controlled. The tumor volume decreased, remained unchanged, or increased after retreatment in 15, 8, and 4 cases, respectively. Four patients had PET during follow-up, and all showed a significant metabolic decrease of the tumor. Hearing was not preserved after retreatment in any patients. New facial or trigeminal palsy did not occur after retreatment.

Conclusions: Our results support the long-term efficacy and low morbidity of repeat GK treatment for selected patients with tumor growth after initial treatment.

No MeSH data available.


Related in: MedlinePlus

Left vestibular schwannoma, first Gamma Knife treatment in 2006 (0.6 cc), second treatment in 2009 (2.0 cc), and last control in 2014
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Figure 1: Left vestibular schwannoma, first Gamma Knife treatment in 2006 (0.6 cc), second treatment in 2009 (2.0 cc), and last control in 2014

Mentions: All patients were followed up clinically and radiologically for a minimum of 24 months after the last GK treatment. The mean follow-up duration was 46 months (range 24–110). No patient died during follow-up. At the last follow-up, 15 tumors had decreased in volume [Figures 1 and 2], 8 tumors remained unchanged, and 4 tumors had increased in volume [Table 3]. Thus, 85% of VS were controlled after re-irradiation. Two patients with increased global tumor volume after GK retreatment had microsurgical tumor resection, and 2 patients with the growth of part of the tumor were treated by a third GK procedure [Figure 3].


Repeat Gamma Knife surgery for vestibular schwannomas.

Lonneville S, Delbrouck C, Renier C, Devriendt D, Massager N - Surg Neurol Int (2015)

Left vestibular schwannoma, first Gamma Knife treatment in 2006 (0.6 cc), second treatment in 2009 (2.0 cc), and last control in 2014
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596053&req=5

Figure 1: Left vestibular schwannoma, first Gamma Knife treatment in 2006 (0.6 cc), second treatment in 2009 (2.0 cc), and last control in 2014
Mentions: All patients were followed up clinically and radiologically for a minimum of 24 months after the last GK treatment. The mean follow-up duration was 46 months (range 24–110). No patient died during follow-up. At the last follow-up, 15 tumors had decreased in volume [Figures 1 and 2], 8 tumors remained unchanged, and 4 tumors had increased in volume [Table 3]. Thus, 85% of VS were controlled after re-irradiation. Two patients with increased global tumor volume after GK retreatment had microsurgical tumor resection, and 2 patients with the growth of part of the tumor were treated by a third GK procedure [Figure 3].

Bottom Line: Four patients had PET during follow-up, and all showed a significant metabolic decrease of the tumor.New facial or trigeminal palsy did not occur after retreatment.Our results support the long-term efficacy and low morbidity of repeat GK treatment for selected patients with tumor growth after initial treatment.

View Article: PubMed Central - PubMed

Affiliation: Gamma Knife Center, Hôpital Erasme, 1070 Brussels, Belgium ; Department of Neurosurgery, Hôpital Erasme, 1070 Brussels, Belgium.

ABSTRACT

Background: Gamma Knife (GK) surgery is a recognized treatment option for the management of small to medium-sized vestibular schwannoma (VS) associated with high-tumor control and low morbidity. When a radiosurgical treatment fails to stop tumor growth, repeat GK surgery can be proposed in selected cases.

Methods: A series of 27 GK retreatments was performed in 25 patients with VS; 2 patients underwent three procedures. The median time interval between GK treatments was 45 months. The median margin dose used for the first, second, and third GK treatments was 12 Gy, 12 Gy, and 14 Gy, respectively. Six patients (4 patients for the second irradiation and 2 patients for the third irradiation) with partial tumor regrowth were treated only on the growing part of the tumor using a median margin dose of 13 Gy. The median tumor volume was 0.9, 2.3, and 0.7 cc for the first, second, and third treatments, respectively. Stereotactic positron emission tomography (PET) guidance was used for dose planning in 6 cases.

Results: Mean follow-up duration was 46 months (range 24-110). At the last follow-up, 85% of schwannomas were controlled. The tumor volume decreased, remained unchanged, or increased after retreatment in 15, 8, and 4 cases, respectively. Four patients had PET during follow-up, and all showed a significant metabolic decrease of the tumor. Hearing was not preserved after retreatment in any patients. New facial or trigeminal palsy did not occur after retreatment.

Conclusions: Our results support the long-term efficacy and low morbidity of repeat GK treatment for selected patients with tumor growth after initial treatment.

No MeSH data available.


Related in: MedlinePlus