Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis
Introduction: Stereotactic radiosurgery (SRS) is a widely used treatment modality for vestibular schwannomas due to its non-invasive nature and high tumor control rates. However, some patients experience tumor progression after treatment. In this setting, reirradiation with SRS represents a potentia...
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Elsevier
2025-09-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630825000813 |
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| author | Noel-Adrian Hollosi Julie Luise Reimers Antonio Santacroce Christoph Fürweger Markus Kufeld Anna M.E. Bruynzeel Joost J.C. Verhoeff Alexander Muacevic Helen A. Shih Felix Ehret |
| author_facet | Noel-Adrian Hollosi Julie Luise Reimers Antonio Santacroce Christoph Fürweger Markus Kufeld Anna M.E. Bruynzeel Joost J.C. Verhoeff Alexander Muacevic Helen A. Shih Felix Ehret |
| author_sort | Noel-Adrian Hollosi |
| collection | DOAJ |
| description | Introduction: Stereotactic radiosurgery (SRS) is a widely used treatment modality for vestibular schwannomas due to its non-invasive nature and high tumor control rates. However, some patients experience tumor progression after treatment. In this setting, reirradiation with SRS represents a potential treatment option. This systematic review and meta-analysis evaluates the evidence for reirradiation of vestibular schwannomas with SRS. Methods: This systematic literature review and meta-analysis investigates the efficacy and safety of reirradiation with SRS for vestibular schwannoma and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: A total of 806 studies were screened and 35 included, comprising 394 reirradiated patients. The median time from first treatment to reirradiation was 45 months (range: 12 – 65 months). Reirradiation with SRS, applying a median marginal/prescription dose of 12 Gy, achieved an estimated local control of 95% (95% confidence interval (CI): 92 – 97%, I2 = 29.62%, p = 0.10). Trigeminal and facial nerve deterioration rates after repeat SRS were 7% (95% CI: 4 – 10%, I2 = 0.0%, p = 0.44) and 6% (95% CI: 3 – 8%, I2 = 0.0%, p = 0.53), respectively. Serviceable hearing after reirradiation with SRS was rare (5%, 95% CI: 2 – 8%, I2 = 0.0%, p = 0.46). Among patients with serviceable hearing before reirradiation, 43% maintained it after treatment (95% CI: 29 – 57%, I2 = 65.71%, p = 0.00). The risk of bias across all studies was high. Conclusion: Reirradiation with SRS appears to be a safe and effective salvage treatment for progressive vestibular schwannomas. Prospective studies are warranted to define the optimal dose, timing, and dose constraints for reirradiation. |
| format | Article |
| id | doaj-art-e37c22de95f24a1d97b5b9fdd8bf3f33 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
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| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-e37c22de95f24a1d97b5b9fdd8bf3f332025-08-20T03:36:19ZengElsevierClinical and Translational Radiation Oncology2405-63082025-09-015410098910.1016/j.ctro.2025.100989Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysisNoel-Adrian Hollosi0Julie Luise Reimers1Antonio Santacroce2Christoph Fürweger3Markus Kufeld4Anna M.E. Bruynzeel5Joost J.C. Verhoeff6Alexander Muacevic7Helen A. Shih8Felix Ehret9Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA; University of Münster, Münster, GermanyUniversity of Lübeck, Lübeck, GermanyEuropean Radiosurgery Center Munich, Munich, Germany; Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany; Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, GermanyEuropean Radiosurgery Center Munich, Munich, GermanyEuropean Radiosurgery Center Munich, Munich, GermanyDepartment of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the NetherlandsDepartment of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the NetherlandsEuropean Radiosurgery Center Munich, Munich, GermanyDepartment of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USAEuropean Radiosurgery Center Munich, Munich, Germany; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; German Cancer Consortium (DKTK), Partner Site Berlin, a Partnership Between DKFZ and Charité – Universitätsmedizin Berlin, Germany; Corresponding author at: Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353 Berlin, Germany.Introduction: Stereotactic radiosurgery (SRS) is a widely used treatment modality for vestibular schwannomas due to its non-invasive nature and high tumor control rates. However, some patients experience tumor progression after treatment. In this setting, reirradiation with SRS represents a potential treatment option. This systematic review and meta-analysis evaluates the evidence for reirradiation of vestibular schwannomas with SRS. Methods: This systematic literature review and meta-analysis investigates the efficacy and safety of reirradiation with SRS for vestibular schwannoma and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: A total of 806 studies were screened and 35 included, comprising 394 reirradiated patients. The median time from first treatment to reirradiation was 45 months (range: 12 – 65 months). Reirradiation with SRS, applying a median marginal/prescription dose of 12 Gy, achieved an estimated local control of 95% (95% confidence interval (CI): 92 – 97%, I2 = 29.62%, p = 0.10). Trigeminal and facial nerve deterioration rates after repeat SRS were 7% (95% CI: 4 – 10%, I2 = 0.0%, p = 0.44) and 6% (95% CI: 3 – 8%, I2 = 0.0%, p = 0.53), respectively. Serviceable hearing after reirradiation with SRS was rare (5%, 95% CI: 2 – 8%, I2 = 0.0%, p = 0.46). Among patients with serviceable hearing before reirradiation, 43% maintained it after treatment (95% CI: 29 – 57%, I2 = 65.71%, p = 0.00). The risk of bias across all studies was high. Conclusion: Reirradiation with SRS appears to be a safe and effective salvage treatment for progressive vestibular schwannomas. Prospective studies are warranted to define the optimal dose, timing, and dose constraints for reirradiation.http://www.sciencedirect.com/science/article/pii/S2405630825000813Vestibular schwannomaAcoustic neuromaStereotactic radiosurgeryRadiosurgeryReirradiation |
| spellingShingle | Noel-Adrian Hollosi Julie Luise Reimers Antonio Santacroce Christoph Fürweger Markus Kufeld Anna M.E. Bruynzeel Joost J.C. Verhoeff Alexander Muacevic Helen A. Shih Felix Ehret Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis Clinical and Translational Radiation Oncology Vestibular schwannoma Acoustic neuroma Stereotactic radiosurgery Radiosurgery Reirradiation |
| title | Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis |
| title_full | Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis |
| title_fullStr | Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis |
| title_full_unstemmed | Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis |
| title_short | Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis |
| title_sort | reirradiation with stereotactic radiosurgery for vestibular schwannomas a systematic review and meta analysis |
| topic | Vestibular schwannoma Acoustic neuroma Stereotactic radiosurgery Radiosurgery Reirradiation |
| url | http://www.sciencedirect.com/science/article/pii/S2405630825000813 |
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