Title: Comparison between observation policy and fractionated stereotactic radiotherapy (SRT) as an initial management for vestibular schwannoma.

Authors: Shirato H, Sakamoto T, Sawamura Y, Kagei K, Isu T, Kato T, Fukuda S, SuzukiK, Soma S, Inuyama Y, Miyasaka K
Location: Department of Radiology, Hokkaido University School of Medicine, Sapporo,Japan. hshirato@radi.med.hokudai.ac.jp

Source: Int J Radiat Oncol Biol Phys 1999 Jun 1;44(3):545-50


PURPOSE: To compare the use of an observation policy with that of stereotactic radiotherapy (SRT) for treatment of vestibular schwannoma.

METHODS AND MATERIALS: The study group consisted of 27 patients who underwent observation as an initial treatment (observation group) and 50 who received SRT (SRT group). The mean follow-up period was 35 months and 31 months, respectively. Stereotactic radiotherapy consisted of small-field fractionated radiotherapy (36-44 Gy in 20-22 fractions over 6 weeks) withor without a subsequent 4-Gy single irradiation boost.

RESULTS: Actuarial tumor control rate of the SRT group was significantly better than that of the observation group (p < 0.0001). The mean growth was 3.87 mm/year in the observation group and -0.75 mm/year in the SRT group (p < 0.0001). Eleven patients (41 %) in the observation group and 1 (2 %) in the SRT group received salvage therapy (p < 0.001). There was no difference in the actuarial Gardner and Robertson's class preservation curves for 5 years after the initial presentation.

CONCLUSION: Stereotactic radiotherapy using a fractionated schedule provides a better tumor control rate and a similar rate of deterioration for hearing levels compared to an observation policy.
Initial SRT may be a reasonable alternative to a wait-and-see policy.

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