Radiotherapy for growing vestibular schwannomas
Abstract
Importance: In the literature, there is a lack of data reporting tumor control rates after radiotherapy in actively growing vestibular schwannomas (VS). Data for this rarely studied population are needed.
Objective: To estimate tumor control rates in radiologically growing VS treated with first-line radiotherapy.
Design, setting, and participants: This international, multicenter cohort study used prospectively collected data from patients with growing unilateral VS treated first-line with radiotherapy between January 2000 and December 2023 from 8 tertiary referral skull base units. The data were analyzed in June 2025.
Exposures: Radiotherapy as an initial treatment for VS.
Main outcomes and measures: The primary outcome was treatment failure, ie VS growth postradiotherapy, which was predefined as an increase in maximum intracranial tumor diameter (ICTD) of 3 mm or greater within the first 2 years after radiotherapy or 2 mm or greater thereafter. Secondary outcomes were treatment failure based on different definitions of VS growth: (1) an increase in ICTD of 2 mm or greater, (2) an increase in ICTD of 3 mm or greater, and (3) conversion to surgery.
Results: A total of 1883 patients (975 female individuals [51.8%]; median age at diagnosis, 63 years [IQR, 53-71 years]) were included in the study. Using the primary definition of treatment failure (an increase in ICTD of ≥3 mm within the first 2 years postradiotherapy or ≥2 mm thereafter), the Kaplan-Meier estimate yielded a 10-year tumor control rate of 76.1% (95% CI, 72.7%-79.2%). For secondary outcome definitions, 10-year tumor control rates were 60.1% (95% CI, 57.5%-64.3%) for an ICTD increase of 2 mm or greater, 78.3% (95% CI, 75.0%-81.2%) for an increase of 3 mm or greater, and 92.6% (95% CI, 90.4%-94.3%) for conversion to surgery. Neither pretreatment tumor size nor tumor location (intracanalicular vs extracanalicular) were significantly associated with treatment failure.
Conclusions and relevance: The results of this cohort study provide tumor control outcomes for radiologically growing VS treated with radiotherapy using several clinically relevant definitions of growth. By focusing exclusively on this rarely isolated subgroup, the findings offer targeted data to potentially inform treatment expectations and future research.
Author
Sethi, Mantegh
Gowrishankar, Shravan
Tysome, James
Donnelly, Neil
Axon, Patrick
Bance, Manohar
Mannion, Richard
Guilfoyle, Mathew
Buttimore, Juliette
Gamazo, Nicola
Duke, Simon
Jena, Raj
Burton, Katherine
Jefferies, Sarah
Fornezza, Umberto
Perini, Zeno
Mari, Cristina
Gazzola, Luca
Schouten, Sammy
Compter, Inge
Eekers, Daniëlle B P
Kunst, Henricus P M
Bassi, Rohan
MacKeith, Samuel
Jeyaretna, Sanjeeva
Whitfield, Gillian
McBain, Catherine
Colaco, Rovel
Hotchkies, Angus
Lloyd, Simon
Obholzer, Rupert
Cheang, Ya Fang Amanda
Thomas, Nick
Barazi, Sinan
Maratos, Eleni
Shapey, Jonathan
Hassan, Sheila
Chia, Kazumi
Tancu, Cornel
Kitchen, Neil
Marinelli, John P
Carlson, Matthew L
Link, Michael J
Borsetto, Daniele
Gowrishankar, Shravan
Tysome, James
Donnelly, Neil
Axon, Patrick
Bance, Manohar
Mannion, Richard
Guilfoyle, Mathew
Buttimore, Juliette
Gamazo, Nicola
Duke, Simon
Jena, Raj
Burton, Katherine
Jefferies, Sarah
Fornezza, Umberto
Perini, Zeno
Mari, Cristina
Gazzola, Luca
Schouten, Sammy
Compter, Inge
Eekers, Daniëlle B P
Kunst, Henricus P M
Bassi, Rohan
MacKeith, Samuel
Jeyaretna, Sanjeeva
Whitfield, Gillian
McBain, Catherine
Colaco, Rovel
Hotchkies, Angus
Lloyd, Simon
Obholzer, Rupert
Cheang, Ya Fang Amanda
Thomas, Nick
Barazi, Sinan
Maratos, Eleni
Shapey, Jonathan
Hassan, Sheila
Chia, Kazumi
Tancu, Cornel
Kitchen, Neil
Marinelli, John P
Carlson, Matthew L
Link, Michael J
Borsetto, Daniele
Date
2025-09-04
Type
Article
Subject
Radiotherapy, Neuroma, acoustic, Otolaryngology, Head and neck neoplasms
Collections
Citation
Sethi M, Gowrishankar S, Tysome J, Donnelly N, Axon P, Bance M, Mannion R, Guilfoyle M, Buttimore J, Gamazo N, Duke S, Jena R, Burton K, Jefferies S, Fornezza U, Perini Z, Mari C, Gazzola L, Schouten S, Compter I, Eekers DBP, Kunst HPM, Bassi R, MacKeith S, Jeyaretna S, Whitfield G, McBain C, Colaco R, Hotchkies A, Lloyd S, Obholzer R, Cheang YFA, Thomas N, Barazi S, Maratos E, Shapey J, Hassan S, Chia K, Tancu C, Kitchen N, Marinelli JP, Carlson ML, Link MJ, Borsetto D. Radiotherapy for Growing Vestibular Schwannomas. JAMA Otolaryngol Head Neck Surg. 2025 Oct 1;151(10):931-937. doi: 10.1001/jamaoto.2025.1953.
Journal / Source Title
JAMA Otolaryngology: Head & Neck Surgery
DOI
10.1001/jamaoto.2025.1953
PMID
40906473
Publisher
American Medical Association
Publisher’s URL
https://jamanetwork.com/journals/jamaotolaryngology