PURPOSE The optimal treatment strategy for vestibular schwannoma (VS) is not known, and different radiation techniques and fractionation regimens are currently being used. This report aimed to assess outcomes after LINAC-based radiosurgery (SRS) and hypofractionated radiotherapy (hypo-FSRT) and identify possible differences in outcomes between hypo-FSRT delivered in 3 or 5 fractions. METHODS From 2005 to 2017, 136 patients underwent treatment with radiotherapy for VS. Thirty-seven patients received SRS (12 Gy), and 99 received hypo-FSRT. Hypo-FSRT was delivered in 3 fractions (total 18-21 Gy, n = 39) and 5 fractions (total 25 Gy, n = 60). RESULTS The median follow-up was 57 months. Eight patients had progression requiring surgery, corresponding to an overall local control rate of 93.4%, with no significant difference between the fractionation schedules. A correlation with borderline significance (p = 0.052) was detected between cystic tumors and local failure. A tendency toward a higher incidence of local failure was observed after 2015 when SRS treatment increased and included slightly larger tumors. Hearing preservation was observed in 35% of patients and 36% of patients experienced acute side effects, but persistent facial or trigeminal nerve toxicity was rare. CONCLUSION SRS and hypo-FSRT with 3 or 5 fractions provided a high rate of local control with no significant differences between treatment schedules. SRS is a well-documented radiation technique for VS and is the recommendation for small- to medium-sized tumors. This report demonstrates excellent long-term outcomes after hypo-FSRT; this regimen can be delivered safely and is an alternative for selected patients.

中文翻译：

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基于LINAC的立体定向放射外科手术与前庭神经鞘瘤分3次或5次分次的超分割立体定向放射治疗：来自单个机构的比较评估。

目的前庭神经鞘瘤（VS）的最佳治疗策略尚不清楚，并且目前正在使用不同的放射技术和分级方案。本报告旨在评估基于LINAC的放射外科手术（SRS）和超分割放射治疗（hypo-FSRT）后的结局，并确定以3或5个分数递送的低FSRT之间结局的可能差异。方法2005年至2017年，136例患者接受了VS放射治疗。37例患者接受了SRS（12 Gy）治疗，其中99例接受了低FSRT治疗。Hypo-FSRT分3部分（总18-21 Gy，n = 39）和5部分（总25 Gy，n = 60）递送。结果中位随访时间为57个月。8例患者需要进行手术，其总体局部控制率为93.4％，分馏方案之间没有显着差异。在囊性肿瘤和局部衰竭之间检测到与临界值相关（p = 0.052）。2015年后，当SRS治疗增加并包括稍大的肿瘤时，观察到局部失败发生率呈上升趋势。在35％的患者和36％的患者中观察到听力保留，但出​​现急性副作用，但是很少出现持续的面部或三叉神经毒性。结论SRS和3分或5分的hypo-FSRT提供高局部控制率，治疗方案之间无显着差异。SRS是一种有据可查的VS放射技术，是对中小型肿瘤的推荐。该报告显示了低速FSRT后长期良好的预后。