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Background <p>Stereotactic radiotherapy (SRT) is a&#xa0;standard treatment for vestibular schwannoma (VS). Long-term comparative data on single-fraction radiosurgery (SRS) versus normofractionated SRT (NFSRT) are limited.</p> Methods <p>We retrospectively analyzed 175 VS patients treated between 1998 and 2023 (SRS <i>n</i> = 69; NFSRT <i>n</i> = 106; median age&#xa0;61&#xa0;years; median follow-up 46&#xa0;months). Tumor control was evaluated with Kaplan–Meier and Cox regression. Group differences were tested with Mann–Whitney&#xa0;U and chi-square/Fisher’s exact tests. Symptom changes were assessed with McNemar tests, and binary logistic regression identified predictors of acute and late toxicity.</p> Results <p>Overall, in-field PFS was 94.3% and out-field was PFS was 99.4%. All 10&#xa0;recurrences (median 58.5&#xa0;months) occurred in NFSRT patients treated with 55.8–56 Gy. Higher total dose predicted recurrence (HR = 2.97; <i>p</i> = 0.003). At baseline, 97.1% reported symptoms (hearing loss 86.9%, vertigo 48.0%, tinnitus 42.3%). After therapy, symptoms remained stable, except the incidence of headache, which increased from 14.3% to 22.3% (<i>p</i> = 0.02). Early toxicities were more common after NFSRT, including headache (OR = 4.05; <i>p</i> = 0.01), fatigue (OR = 5.12; <i>p</i> = 0.01), and alopecia (OR = 19.9; <i>p</i> = 0.04), but had resolved by late follow-up. Age and prior surgery predicted vertigo patterns over time. Radionecrosis was rare (0.6%).</p> Conclusion <p>Both SRS and NFSRT achieve excellent long-term tumor control with low severe toxicity. For NFSRT, normofractionated doses above 55 Gy did not improve efficacy and may increase the recurrence risk, supporting moderate-dose regimens (50–54 Gy). Symptom stabilization confirms the safety of SRT, though headache and vertigo remain relevant long-term issues. Careful dose selection, patient counseling, and rehabilitation are essential to optimize outcomes.</p>

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Comparative analysis of different modalities of radiotherapy in vestibular schwannoma: tumor control, symptom evolution, and toxicity profiles

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月27日

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  • Phillipp Lishewski,
  • Maike Fischer,
  • Kerem Tuna Tas,
  • Fatima Frosan Sheikhzadeh,
  • Edgar Smalec,
  • Linda Agolli,
  • Christopher Nimsky,
  • André Kemmling,
  • Daniel Habermehl,
  • Klemens Zink,
  • Ahmed Gawish,
  • Sebastian Adeberg

摘要

Background

Stereotactic radiotherapy (SRT) is a standard treatment for vestibular schwannoma (VS). Long-term comparative data on single-fraction radiosurgery (SRS) versus normofractionated SRT (NFSRT) are limited.

Methods

We retrospectively analyzed 175 VS patients treated between 1998 and 2023 (SRS n = 69; NFSRT n = 106; median age 61 years; median follow-up 46 months). Tumor control was evaluated with Kaplan–Meier and Cox regression. Group differences were tested with Mann–Whitney U and chi-square/Fisher’s exact tests. Symptom changes were assessed with McNemar tests, and binary logistic regression identified predictors of acute and late toxicity.

Results

Overall, in-field PFS was 94.3% and out-field was PFS was 99.4%. All 10 recurrences (median 58.5 months) occurred in NFSRT patients treated with 55.8–56 Gy. Higher total dose predicted recurrence (HR = 2.97; p = 0.003). At baseline, 97.1% reported symptoms (hearing loss 86.9%, vertigo 48.0%, tinnitus 42.3%). After therapy, symptoms remained stable, except the incidence of headache, which increased from 14.3% to 22.3% (p = 0.02). Early toxicities were more common after NFSRT, including headache (OR = 4.05; p = 0.01), fatigue (OR = 5.12; p = 0.01), and alopecia (OR = 19.9; p = 0.04), but had resolved by late follow-up. Age and prior surgery predicted vertigo patterns over time. Radionecrosis was rare (0.6%).

Conclusion

Both SRS and NFSRT achieve excellent long-term tumor control with low severe toxicity. For NFSRT, normofractionated doses above 55 Gy did not improve efficacy and may increase the recurrence risk, supporting moderate-dose regimens (50–54 Gy). Symptom stabilization confirms the safety of SRT, though headache and vertigo remain relevant long-term issues. Careful dose selection, patient counseling, and rehabilitation are essential to optimize outcomes.