Journal article
Outcomes of Repeat Stereotactic Radiosurgery for Recurrent or Progressive Sporadic Vestibular Schwannoma: A Multicenter International Study
Neurosurgery
05 Dec 2025
PMID: 41347795
Abstract
Repeat stereotactic radiosurgery (SRS) is a noninvasive option for recurrent vestibular schwannoma (VS). This study evaluates outcomes in patients with long-term follow-up.
This retrospective multicenter study analyzed 81 patients with recurrent unilateral sporadic VS after initial SRS, with ≥12 months of follow-up. Outcomes included tumor control, hearing preservation, cranial nerve function, and adverse radiation effects (ARE). Kaplan-Meier and Cox regression identified factors affecting outcomes.
The median age at the second SRS was 60 years, with a median interval of 58 months between procedures. The median margin doses were 12.0 Gy (single-fraction), 17.25 Gy (3-fraction), and 25 Gy (5-fraction). Tumor control was achieved in 69 patients (85.2%), with 5- and 10-year local control rates of 82% and 76.5%, respectively. Significant predictors of local failure included tumor volume >2.2 cm3 (area under the curve = 0.757, P = .018), prescription biological effective dose (BED) ≤70.3 Gy (hazard ratio [HR]: 0.89, P = .003), and interval between treatments >27.5 months (HR: 1.02, P = .015). In single-fraction SRS, higher prescription dose reduced failure risk (HR: 0.31, P = .002) with a margin dose ≥12 Gy being critical for improved tumor control (P < .001). Serviceable hearing was retained in 12 of 18 cases (66.7%), and facial nerve function was preserved in 72 of 80 cases (90%). ARE occurred in 11 patients (13.6%), most commonly perilesional edema (63.7%). ARE correlated with higher brainstem maximum BED in the entire cohort (HR: 1.02, P = .016) and in single-fraction SRS (HR: 1.02, P = .006). Pseudoprogression (9.8%) was linked to younger age (HR: 0.88, P = .023) and shorter time between SRS (HR: 0.87, P = .012).
Repeat SRS is an effective option for recurrent sporadic VS, offering high tumor control and functional preservation. Outcomes depend on age, interval between treatments, tumor volume, and BED. With careful planning, adverse effects are rare and typically transient.
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Details
- Title
- Outcomes of Repeat Stereotactic Radiosurgery for Recurrent or Progressive Sporadic Vestibular Schwannoma: A Multicenter International Study
- Creators
- Salem M Tos - University of VirginiaMariam Ishaque - University of VirginiaGeorgios Mantziaris - University of VirginiaBardia Hajikarimaloo - University of VirginiaKeiss Douri - Université de SherbrookeDavid Mathieu - Université de SherbrookeAhmed M Nabeel - Nasser Institute hospitalWael A Reda - Ain Shams UniversitySameh R Tawadros - Ain Shams UniversityKhaled Abdelkarim - Nasser Institute hospitalAmr M N El-Shehaby - Ain Shams UniversityReem M Emad - Cairo UniversityAnais Andrade de Moura - Department of Neurosurgery, NYU Langone, Manhattan, New York, USAKenneth Bernstein - Manhattan Institute for Policy ResearchNuria Martinez Moreno - Hospital Ruber InternacionalRoberto Martinez Alvarez - Hospital Ruber InternacionalDavid Bailey - Penn State Milton S. Hershey Medical CenterJames McInerney - Penn State Milton S. Hershey Medical CenterBrad E Zacharia - Penn State Milton S. Hershey Medical CenterSelcuk Peker - Koç UniversityA Haluk Duzkalir - Koç UniversityManjul Tripathi - Post Graduate Institute of Medical Education and ResearchRupinder Kaur - Post Graduate Institute of Medical Education and ResearchGreg N Bowden - University of AlbertaPiero Picozzi - IRCCS Humanitas Research HospitalAndrea Franzini - IRCCS Humanitas Research HospitalTakuma Sumi - Dokkyo Medical UniversityHideyuki Kano - Dokkyo Medical UniversityMatthew J Shepard - Allegheny Health NetworkRodney E Wegner - Allegheny Health NetworkPavnesh Kumar - The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteJoshua D Palmer - The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteDavid Schlesinger - University of VirginiaChris Z Wei - Neurological SurgeryVanshika Lohia - University of PittsburghAjay Niranjan - University of PittsburghL Dade Lunsford - University of PittsburghDouglas Kondziolka - Manhattan Institute for Policy ResearchJason P Sheehan - University of Virginia
- Publication Details
- Neurosurgery
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Other Identifier
- 991022155291204721