Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review

Acta Neurochir (Wien). 2017 Jun;159(6):1013-1021. doi: 10.1007/s00701-017-3164-6. Epub 2017 Apr 13.


Objective: Repeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) <3 cm in need of intervention. In this systematic review we aimed to compare results from single-fraction stereotactic radiosurgery (SRS) to fractionated stereotactic radiotherapy (FSRT) for patients with VS.

Data sources and eligibility criteria: We systematically searched MEDLINE, Web of Science, Embase and Cochrane and screened relevant articles for references. Publications from 1995 through 2014 with a minimum of 50 adult (>18 years) patients with unilateral VS, followed for a median of >5 years, were eligible for inclusion. After screening titles and abstracts of the 1094 identified articles and systematically reviewing 98 of these articles, 19 were included.

Intervention: Patients with unilateral VS treated with radiosurgery were compared to patients treated with fractionated stereotactic radiotherapy.

Results: No randomized controlled trial (RCT) was identified. None of the identified controlled studies comparing SRS with FSRT were eligible according to the inclusion criteria. Nineteen case series on SRS (n = 17) and FSRT (n = 2) were included in the systematic review. Loss of tumor control necessitating a new VS-targeted intervention was found in an average of 5.0% of the patients treated with SRS and in 4.8% treated with FSRT. Mean deterioration ratio for patients with serviceable hearing before treatment was 49% for SRS and 45% for FSRT, respectively. The risk for facial nerve deterioration was 3.6% for SRS and 11.2% for FSRT and for trigeminal nerve deterioration 6.0% for SRS and 8.4% for FSRT. Since these results were obtained from case series, a regular meta-analysis was not attempted.

Conclusion: SRS and FSRT are both noninvasive treatment alternatives for patients with VS with low rates of treatment failure in need of rescue therapy. In this selection of patients, the progression-free survival rates were on the order of 92-100% for both treatment options. There is a lack of high-quality studies comparing radiation therapy alternatives for patients with VS. Finally, 19 articles reported long-term tumor control after SRS, while only 2 articles reported long-term FSRT results, making effect estimates more uncertain for FSRT.

Keywords: Fractionated stereotactic radiotherapy; Gamma Knife; LINAC; Stereotactic radiosurgery; Vestibular schwannoma.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Disease-Free Survival
  • Dose Fractionation, Radiation
  • Facial Nerve / surgery
  • Female
  • Humans
  • Male
  • Microsurgery / adverse effects*
  • Microsurgery / methods
  • Neuroma, Acoustic / surgery*
  • Postoperative Complications / epidemiology*
  • Radiosurgery / adverse effects*
  • Radiosurgery / methods
  • Trigeminal Nerve / surgery