Abstract
Vestibular schwannomas (VSs) are comparatively rare in younger patients, and stereotactic radiosurgery (SRS) outcome data are limited. We aimed to evaluate long-term SRS outcomes concerning sporadic VSs in patients aged ≤ 40years. Of 383 patients with VS who had undergone SRS at our institution between 1990 and 2017, we retrospectively compared younger and older patients' tumor control and radiation-induced complication rates using case-control propensity score (PS) matching. The mean follow-up was 83 and 92months in older and younger patients, respectively. Compared with older patients, younger patients were more likely to have a history of resection (20% vs. 39%, p = 0.006) and be treated with higher marginal doses (median, 12Gy vs. 14Gy; p = 0.014). Cumulative 5- and 10-year tumor control rates were higher in older patients (97.7% and 93.9%, respectively) than in younger patients (90.2% and 85.4%, respectively, p = 0.024). After PS matching, younger patients' cumulative tumor control rates (93.6%, 85.4%, and 85.4% at 5, 10, and 15years, respectively) were similar to those of older patients (p = 0.411). No significant between-cohort differences in hearing preservation rates or other cranial nerve complications were observed. Two younger patients had malignant tumors several years post-SRS, with one patient having confirmed histological transformation. SRS is equally effective for younger and older patients. Complications other than hearing deterioration are uncommon. However, malignant transformation is possible, and long-term post-SRS surveillance MRI is important. These data are useful for decision-making involving young adults with VSs.
Highlights
Stereotactic radiosurgery (SRS) for small- to medium-sized vestibular schwannomas (VSs) is a safe and effective treatment [1,2,3,4,5]
While surgical outcomes have improved significantly due to advances in microsurgery and electrophysiological monitoring techniques [10], the surgical burden remains high for patients, including inability to work for a significant period
Younger patients were more likely to have a history of resection (20% vs. 39%; p = 0.006) and to have been treated with higher marginal doses
Summary
Stereotactic radiosurgery (SRS) for small- to medium-sized vestibular schwannomas (VSs) is a safe and effective treatment [1,2,3,4,5]. It has been proposed that VSs in younger patients could have different biological features, such as a larger tumor size, high vascularity, and rapid growth [7,8,9], and attention to treatment outcomes in this age group is needed. Younger patients tend to have a longer life expectancy than do their older counterparts; differences between treatment modalities could be amplified over time. While several studies have reported long-term SRS outcomes across several age groups, such data are limited in younger patients. Since younger patients have an increased risk of recurrence due to their longer follow-up periods, detailed outcomes of SRS as a salvage treatment for recurrence in this age group would be informative. This study aimed to compare long-term SRS outcomes concerning VSs between younger and older patients to provide useful information for treatment decisionmaking
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