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Using the deformity index of vital structures to predict outcome of patients with large vestibular schwannomas after Gamma Knife radiosurgery.

Authors :
Chang, Hao-Chun
You, Weir Chiang
Shen, Chiung-Chyi
Chen, Ying Ju
Sun, Ming-His
Sheu, Meei-Ling
Pan, Liang-Yi
Sheehan, Jason
Su, Kuo-Chih
Pan, Hung-Chuan
Source :
Journal of Neuro-Oncology; Mar2023, Vol. 162 Issue 1, p179-189, 11p
Publication Year :
2023

Abstract

Purpose: Microsurgery is the mainstay of treatment for large vestibular schwannomas (VS), but the benefits of radiosurgery remain incompletely defined. Here, we aim to use automated volumetric analysis software to quantify the degree of brain stem deformity to predict long-term outcomes of patients with large VS following GKRS. Methods: Between 2003 and 2020, 39 patients with large VS (volume > 8 cc) undergoing GKRS with a margin dose of 10–12 Gy were analyzed. The reconstruction 3D MRI was used to evaluate the extent of deformity for predicting the long-term outcome of patients. Results: Their mean tumor volume was 13.7 ± 6.3 cc, and their mean follow-up after GKRS was 86.7 ± 65.3 months. Favorable clinical outcome was observed in 26 (66.7%) patients, while 13 (33.3%) patients had treatment failure. Patients with small tumor volumes, low vital structure deformity indice [(TV/(BSV + CerV) and (TV + EV)/(BSV + CerV)], and long distance of tumor to the central line were more likely to have favorable clinical outcome after GKRS. Significant prognostic value was with tumor shrinkage ratio (< 50%) were CV, CV/TV, TV/CerV, (TV + EV)/(BSV + CerV), and the distance of tumor to the central line. In cox regression, favorable clinical outcome was correlated with the Charlson comorbidity index and cochlear dosage (both p < 0.05). In multivariant analysis, tumor regression was highly correlated with the CV/TV ratio (p < 0.001). Conclusions: The brainstem deformity ratio is likely a useful index to assess the clinical and tumor regression outcomes. Clinical outcomes are multifactorial and the tumor regression was highly correlated with the ratio of cystic components. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
0167594X
Volume :
162
Issue :
1
Database :
Complementary Index
Journal :
Journal of Neuro-Oncology
Publication Type :
Academic Journal
Accession number :
162727262
Full Text :
https://doi.org/10.1007/s11060-023-04280-z