Risk Analysis of Radiosurgery for Vestibular Schwannoma: Systematic Review and Comparative Study of 10-Year Outcomes

Authors

Kevin M. Guy, University of Maryland Medical Center
April A. Pace, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
Derek S. Tsang, Princess Margaret Cancer Centre, University Health Network
Peter G. Volsky, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow

ORCID

0000-0002-9760-7639 (Pace), 0000-0002-5247-8562 (Volsky)

Document Type

Article

Publication Date

2025

DOI

10.1093/noajnl/vdae191

Publication Title

Neuro-Oncology Advances

Volume

7

Issue

1

Pages

vdae191 (1-12)

Abstract

Background: Determine the benefit of stereotactic radiosurgery (SRS) compared to no treatment for sporadic vestibular schwannoma (VS) by calculating epidemiologic risk using 10-year data; apply the analysis to VS that have demonstrated linear growth.

Methods: PubMed, Google Scholar, Web of Science, and Cochrane Library are systematically reviewed for VS tumor control 10 years after SRS and compared to an historical cohort of untreated VS (primary risk analysis). Subgroups of VS limited by size and observed growth are compared to the untreated cohort (secondary analysis).

Results: Twenty-four studies of 4,079 SRS-treated VS exhibited tumor control in 90.93% (87.0%-100%; SD 4.1%), while 1959 untreated VS exhibited control in 65.24%. SRS reduces the absolute risk (ARR) of tumor progression by 25.7% compared to no treatment. The number needed to treat (NNT) is 4 (3.892, 95% CI: 3.619 to 4.210). Subgroup analyses of (1) VS with definite linear growth before SRS result in similar ARR 29.4% and NNT 4 (3.395, 95% CI: 2.966-3.968), and (2) Koos 1 VS result in lower ARR 18.31% and higher NNT 6 (5.209; 95% CI: 4.018 - 7.401).

Conclusions: This “best-available” case-control study of 10-year data reveals that ARR and NNT are similar for VS with and without definite pre-treatment linear growth. These comparisons may be applied to CPA diameters less than 2 cm. Results for Koos 1 tumors are different. This analysis quantifies the therapeutic benefit of SRS by comparative risk analysis. The level of evidence on this topic is low.

Rights

© The Authors 2024.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site- for further information please contact journals.permissions@oup.com.

Data Availability

Article states: "The data used to conduct this systematic review will be made available upon reasonable request."

Original Publication Citation

Guy, K. M., Pace, A. A., Tsang, D. S., & Volsky, P. G. (2025). Risk analysis of radiosurgery for vestibular schwannoma: Systematic review and comparative study of 10-year outcomes. Neuro-Oncology Advances, 7(1), 1-12, Article vdae191. https://doi.org/10.1093/noajnl/vdae191

Repository Citation

Guy, K. M., Pace, A. A., Tsang, D. S., & Volsky, P. G. (2025). Risk analysis of radiosurgery for vestibular schwannoma: Systematic review and comparative study of 10-year outcomes. Neuro-Oncology Advances, 7(1), 1-12, Article vdae191. https://doi.org/10.1093/noajnl/vdae191