Mulder Jef J S, Kaanders Johannes H, van Overbeeke Jacobus J, Cremers Cor W R J
Department of Otolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Curr Opin Otolaryngol Head Neck Surg. 2012 Oct;20(5):367-71. doi: 10.1097/MOO.0b013e328357d337.
Recently, new information on the natural course and on the results of radiation therapy of vestibular schwannomas has been published. The aim of this study is to summarize the most recent literature on the contemporary insights on the natural course and the results of the latest strategies of radiotherapy for vestibular schwannomas.
After diagnosis only about one-third of all vestibular schwannomas will progress. Many patients do well with a 'wait and see' policy and, when necessary, radiation treatment has the advantage that tumor control rates are high (95%) and treatment-related side effects are very low. Different approaches to radiotherapy continue to evolve. Up till now stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) yield comparable results both in terms of tumor control and cranial nerve preservation. With new data available on hearing preservation after radiotherapy, a watchful waiting policy is a renewed matter of debate.
When a vestibular schwannoma grows, radiotherapy (SRS or FSRT) may be a valuable treatment modality. Future clinical research (properly designed randomized trials) should focus on when and when not to treat, even if a vestibular schwannoma is not growing and on potential differences in long-term effects between SRS and fractionated radiotherapy.
最近，关于前庭神经鞘瘤自然病程及放射治疗结果的新信息已发表。本研究的目的是总结关于前庭神经鞘瘤自然病程的当代见解以及最新放射治疗策略结果的最新文献。
诊断后，所有前庭神经鞘瘤中只有约三分之一会进展。许多患者采用“观察等待”策略效果良好，必要时，放射治疗具有肿瘤控制率高（95%）且治疗相关副作用非常低的优势。放射治疗的不同方法不断发展。到目前为止，立体定向放射外科（SRS）和分次立体定向放射治疗（FSRT）在肿瘤控制和颅神经保留方面产生了可比的结果。随着放射治疗后听力保留的新数据可用，观察等待策略再次成为争论的焦点。
当前庭神经鞘瘤生长时，放射治疗（SRS或FSRT）可能是一种有价值的治疗方式。未来的临床研究（设计合理的随机试验）应关注何时治疗以及何时不治疗，即使前庭神经鞘瘤没有生长，以及SRS和分次放射治疗在长期效果上的潜在差异。
