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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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
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| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630825000813 |
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| Summary: | 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. |
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| ISSN: | 2405-6308 |