Stereotactic radiosurgery for vestibular schwannomas in neurofibromatosis type 2 patients: a systematic review and meta-analysis

被引:10
|
作者
Tosi, Umberto [1 ]
Maayan, Omri [1 ]
An, Anjile [2 ]
Lavieri, Miguel E. Tusa [1 ]
Guadix, Sergio W. [1 ]
DeRosa, Antonio P. [3 ,4 ]
Christos, Paul J. [2 ]
Pannullo, Susan [1 ]
Stieg, Philip E. [1 ]
Brandmaier, Andrew [5 ]
Knisely, Jonathan P. S. [5 ]
Ramakrishna, Rohan [1 ]
机构
[1] Weill Cornell Med, Dept Neurol Surg, 525 E 68th St,Box 99, New York, NY 10065 USA
[2] Weill Cornell Med, Div Biostat & Epidemiol, Dept Healthcare Policy & Res, New York, NY USA
[3] Weill Cornell Med, Samuel J Wood Lib, New York, NY USA
[4] Weill Cornell Med, CV Starr Biomed Informat Ctr, New York, NY USA
[5] Weill Cornell Med, Dept Radiat Oncol, New York, NY USA
关键词
Neurofibromatosis type 2; Vestibular schwannoma; Acoustic neuroma; Radiosurgery; GAMMA-KNIFE RADIOSURGERY; TUMOR-CONTROL; HEARING PRESERVATION; NATURAL-HISTORY; NERVOUS-SYSTEM; MANAGEMENT; RADIOTHERAPY; NF2; SURGERY; COMPLICATIONS;
D O I
10.1007/s11060-021-03910-8
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction Neurofibromatosis type 2 (NF2) is characterized by often bilateral vestibular schwannomas (VS) that result in progressive hearing loss and compression of nearby brainstem structures causing cranial nerve palsies. Treatment of these tumors remains challenging, as both surgical removal and expectant management can result in symptom progression. Stereotactic radiosurgery (SRS) has been investigated for the management of NF2-associated VS; however, the role, promises, and pitfalls of this treatment modality remain unclear. Methods Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Reviews were searched for studies assessing SRS outcome in NF2-associated VS only. Primary endpoints included tumor control, serviceable hearing, presence of tinnitus, and cranial nerve V and VII symptoms. Results A total of 16 studies (589 patients harboring 750 tumors) were analyzed. Clinical tumor control was achieved in 88% of cases (95% CI 80-95%); salvage surgery was needed in 8% (95% CI 4-13%) of cases. Treatment resulted in a worsening of pre-treatment serviceable hearing (OR = 0.26, p < 0.01), increased facial nerve (OR = 1.62, p < 0.01) and trigeminal nerve (OR = 1.42, p = 0.07) impairment. The incidence of vestibular symptoms and hydrocephalus were not consistently reported and thus could not be assessed. Conclusions The treatment of NF2-associated VS continues to pose a challenge, as current SRS regimens result in impaired hearing and worse cranial nerve comorbidities, despite achieving high tumor control. It remains unclear if these findings have to be regarded as treatment complications or, rather, continued disease progression.
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收藏
页码:431 / 441
页数:11
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