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Optimal Volume of the Residual Tumor to Predict Long-term Tumor Control Using Stereotactic Radiosurgery after Facial Nerve-preserving Surgery for Vestibular Schwannomas

Journal of Korean Medical Science 2021년 36권 16호 p.102 ~ 102
이원재, 이정일, 최정원, 공두식, 남도현, 조양선, 신형진, 설호준,
소속 상세정보
이원재 ( Lee Won-Jae ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery
이정일 ( Lee Jung-Il ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery
최정원 ( Choi Jung-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery
공두식 ( Kong Doo-Sik ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery
남도현 ( Nam Do-Hyun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery
조양선 ( Cho Yang-Sun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Otorhinolaryngology-Head and Neck Surgery
신형진 ( Shin Hyung-Jin ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery
설호준 ( Seol Ho-Jun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery

Abstract


Background: Intended subtotal resection (STR) followed by adjuvant gamma knife radiosurgery (GKRS) has emerged as an effective treatment option for facial nerve (FN) preservation in vestibular schwannomas (VSs). This study aimed to identify the optimal cut-off volume of residual VS to predict favorable outcomes in terms of both tumor control and FN preservation.

Methods: This retrospective study assessed the patients who underwent adjuvant GKRS for residual VS after microsurgery. A total of 68 patients who had been followed up for ≥ 24 months after GKRS were included. Tumor progression was defined as an increase in tumor volume (TV) of ≥ 20%. House-Brackmann grades I and II were considered to indicate good FN function.

Results: The median residual TV was 2.5 cm3 (range: 0.3?27.4). The median follow-up period after the first adjuvant GKRS was 64 months (range: 25.7?152.4). Eight (12%) patients showed tumor progression. In multivariate analyses, residual TV was associated with tumor progression (P = 0.003; hazard ratio [HR], 1.229; 95% confidence interval [CI], 1.075?1.405). A residual TV of 6.4 cm3 was identified as the cut-off volume for showing the greatest difference in progression-free survival (PFS). The 5-year PFS rates in the group with residual TVs of < 6.4 cm3 (54 patients) and that with residual TVs of ≥ 6.4 cm3 (14 patients) were 93.3% and 69.3%, respectively (P = 0.014). A good FN outcome was achieved in 57 (84%) patients. Residual TV was not associated with good FN function during the immediate postoperative period (P = 0.695; odds ratio [OR], 1.024; 95% CI, 0.908?1.156) or at the last follow-up (P = 0.755; OR, 0.980; 95% CI, 0.866?1.110).

Conclusion: In this study, residual TV was associated with tumor progression in VS after adjuvant GKRS following STR. As preservation of FN function is not correlated with the extent of resection, optimal volume reduction is imperative to achieve long-term tumor control. Our findings will help surgeons predict the prognosis of residual VS after FN-preserving surgery.

키워드

Gamma Knife Radiosurgery; Vestibular Schwannoma; Facial Nerve; Tumor Volume

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