Fractionated radiation therapy in the treatment of fast-growing cerebello-pontine angle schwannomas:: Twelve-years experience in 30 cases

Twenty-nine patients (30 tumors) with large and/or fast-growing CPA schwannomas were treated with external fractionated radiation therapy. One patient was irradiated on both sides and indication to radiotherapy tvas as follows: (a) poor general condition or old age, 16 cases; (b) hearing preservation in bilateral neurinomas, 6 cases; (c) partial resection or high risk of recurrence, 5 cases; (d) relapse, 3 cases. A three to four-field technique with coplanar static beams and conformal blocks was used. Doses were calculated on a 95% isodose and were given 5 days a week for a mean total dose of 51 Gy (1.80 Gy/fraction). Median follow-up from RT was 66 months (7 to 120); seven patients died, two with progressive disease, five from non-tumoral causes. Two patients underwent total tumor removal after RT). On the whole, tumor shrinkage was observed in 13 patients (43.3%), stable disease in 14 (46.6%), and tumor progression in 3. Anacusis was observed in only 2 of the 6 hearing patients. No patient experienced facial or trigeminal Long-term efficacy of fractionated RT is well documented in this series. Acute and delayed tolerance was excellent. Hearing can be preserved for a long time.