The role of radiosurgery in the combined treatment of large vestibular schwannomas
Keywords:vestibular schwannoma, combined treatment, microsurgery, stereotactic radiosurgery, linear accelerator
Purpose. To optimize treatment tactics at large vestibular schwannoma (VS) based on stereotactic radiosurgery (SRS) results analysis and efficiency evaluation as the post-operative phase of combined treatment.
Materials and methods. 22 patients with large VS, previously operated in 2010–2014 were included in the study. SRS was performed using linear accelerator “Trilogy” (“Varian”, USA). Target irradiation size was in average was 8,617 cm3, prescribed dose (PD) — 12.54 Gy, the maximum dose — 14.3 Gy.
Results. The observation period after SRS ranged from 7 to 48 months, on an average — 26.7 months. Monitoring included regular clinical and radiological examinations: for the first year of observation — every 3 months, further — every 6 months. In 18 patients in a period of 12 months the size of the irradiated HS decreased or remained unchanged in 78%, in 15 patients in a period of 24 months — 93%, and in all 5 patients in a period 36 months. After SRS neurological status improved in 45% patients, functional status (according to the Karnofsky scale) — in 26%.
Conclusions. SRS as a post-operative phase of large VS combined treatment ensured control of tumor growth, improved patient’s functional state, reduced neurological deficits, minimized risk associated with cranial nerves dysfunction.
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