Repeat stereotactic radiosurgery in vestibular schwannoma patients: A systematic review and meta-analysis

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BackgroundRegarding the newly diagnosed vestibular schwannomas (VSs), active surveillance, microsurgical resection (MS), and stereotactic radiosurgery (SRS) are the leading treatment options. Although SRS is an effective intervention with a low incidence of complications, failure may occur occasionally. Several options, including repeat SRS, are considered salvage treatment after failure of the SRS. In this systematic review and meta-analysis study, we aimed to evaluate the efficacy and outcomes of repeat stereotactic radiosurgery (SRS) in progressive VS following the failure of the initial SRS. MethodThe electronic databases of PubMed/Medline, Scopus, Embase, and Web of Science (WOS) were searched from inception to August 23rd, 2024. Studies that evaluated the role of repeat SRS in the setting of VS were included. The risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool. The R program performed the meta-analyses, sensitivity analysis, publication bias, and meta-regression. ResultsA total of 11 studies encompassing 260 VS patients with repeat SRS were included in our study. The median time interval between initial and repeat SRSs ranged from tumor volume ranged from 43 to 62 months. Our analysis revealed a pooled tumor control of 91 % (95 % CI: 86 %-94 %). Regarding the radiological response, the pooled regression rate was 59 % (95 % CI: 52 %- 65 %), while the pooled progression rate was 9 % (95 % CI: 6 %- 14 %). Regarding the clinical outcomes, the pooled serviceable hearing preservation (SHP) rate was 36 % (95 % CI: 22 %-53 %), while worsened fifth cranial nerve (CN) and seventh CN rates were 12 % (95 % CI: 7 %- 19 %) and 8 % (95 % CI: 5 %- 12 %), respectively. In addition, the pooled adverse radiation effect (ARE) rate was 6 % (95 % CI: 3 %- 11 %). ConclusionOur results suggest that the repeat SRS following the failure of the initial SRS in VS is associated with favorable outcomes, including tumor control, SHP, and CN worsening concurrent with low ARE rates.