Last updated March 14, 2022

Role of Radiosurgery and Radiation Therapy in the Management of Patients With Vestibular Schwannomas

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)
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When there has been progression of tumor after SRS, SRS can be safely and effectively performed as a retreatment.
(Evidence Level 3)
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Patients should be informed that there is minimal risk of malignant transformation of vestibular schwannomas after SRS.
(Evidence Level 3)
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Recommendation Grading

Overview

Title

Role of Radiosurgery and Radiation Therapy in the Management of Patients With Vestibular Schwannomas

Authoring Organization

Publication Month/Year

February 1, 2018

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

Methodology

Number of Source Documents
139
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 31, 2014