Role of Radiosurgery and Radiation Therapy in the Management of Patients With Vestibular Schwannomas
Publication Date: February 1, 2018
Last Updated: March 14, 2022
Recommendations
RADIOSURGERY VS OBSERVATION
If tinnitus is not observed at presentation, it is recommended that intracanalicular vestibular schwannomas and small tumors (<2 cm) without tinnitus be observed as observation does not have a negative impact on tumor growth or hearing preservation compared to treatment.
(Evidence Level 3)
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RADIOSURGERY TECHNOLOGY
There are no studies that compare 2 or all 3 modalities -- Gamma Knife (Elekta, Stockholm, Sweden) vs linear accelerator-based radiosurgery vs proton beam. Thus, recommendations on outcome based on modality cannot be made.
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RADIOSURGERY TECHNIQUE
Since there is no difference in radiographic control using different doses, it is recommended that for single fraction SRS doses, <13 Gy be used to facilitate hearing preservation and minimize new onset or worsening of preexisting cranial nerve deficits.
(Evidence Level 3)
6731
Since there is no difference in radiographic control and clinical outcome using single or multiple fractions, no recommendations can be given.
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RADIOGRAPHIC FOLLOW-UP, RETREATMENT, AND TUMORIGENESIS AFTER RADIOSURGERY
Follow-up imaging should be obtained at intervals after SRS based on clinical indications, a patient’s personal circumstances, or institutional protocols. Long-term follow-up with serial magnetic resonance imagings to evaluate for recurrence is recommended. No recommendations can be given regarding the interval of these studies.
(Evidence Level 3)
6731
When there has been progression of tumor after SRS, SRS can be safely and effectively performed as a retreatment.
(Evidence Level 3)
6731
Patients should be informed that there is minimal risk of malignant transformation of vestibular schwannomas after SRS.
(Evidence Level 3)
6731
Recommendation Grading
Overview
Title
Role of Radiosurgery and Radiation Therapy in the Management of Patients With Vestibular Schwannomas
Authoring Organization
Congress of Neurological Surgeons
Publication Month/Year
February 1, 2018
Last Updated Month/Year
August 7, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Operating and recovery room
Intended Users
Physician, nurse, nurse practitioner, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D015837 - Vestibular Diseases, D011827 - Radiation, D016634 - Radiosurgery
Keywords
radiation therapy, vestibular schwannomas, radiosurgery, Fractionated radiotherapy, Gamma Knife, LINAC, Proton beam
Supplemental Methodology Resources
Methodology
Number of Source Documents
139
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 31, 2014