Guy Kevin M, Pace April A, Tsang Derek S, Volsky Peter G
Department of Otolaryngology, University of Maryland Medical Center, Baltimore, Maryland, USA.
Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, USA.
Neurooncol Adv. 2024 Nov 25;7(1):vdae191. doi: 10.1093/noajnl/vdae191. eCollection 2025 Jan-Dec.
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.
PubMed, Google Scholar, Web of Science, and Cochrane Library are systematically reviewed for VS tumor control 10 years after SRS and compared to a 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).
Twenty-four studies of 4079 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: 3.619-4.210). Subgroup analyses of (1) VS with definite linear growth before SRS result in a similar ARR of 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).
This "best-available" case-control study of 10-year data reveals that ARR and NNT are similar for VS with and without definite pretreatment 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.
通过使用10年数据计算流行病学风险，确定立体定向放射外科治疗（SRS）相较于不治疗散发性前庭神经鞘瘤（VS）的益处；将该分析应用于已显示线性生长的VS。
系统检索PubMed、谷歌学术、科学网和考克兰图书馆，以获取SRS治疗10年后VS的肿瘤控制情况，并与未治疗VS的历史队列进行比较（主要风险分析）。将受大小和观察到的生长限制的VS亚组与未治疗队列进行比较（次要分析）。
对4079例接受SRS治疗的VS的24项研究显示，肿瘤控制率为90.93%（87.0%-100%；标准差4.1%），而1959例未治疗的VS的肿瘤控制率为65.24%。与不治疗相比，SRS将肿瘤进展的绝对风险（ARR）降低了25.7%。治疗所需人数（NNT）为4（3.892，95%置信区间：3.619-4.210）。（1）SRS前有明确线性生长的VS亚组分析显示，ARR相似，为29.4%，NNT为4（3.395，95%置信区间：2.966-3.968），（2）库斯1级VS的ARR较低，为18.31%，NNT较高，为6（5.209；95%置信区间：4.018-7.401）。
这项基于10年数据的“现有最佳”病例对照研究表明，有或没有明确预处理线性生长的VS的ARR和NNT相似。这些比较可应用于桥小脑角直径小于2 cm的情况。库斯1级肿瘤的结果不同。该分析通过比较风险分析量化了SRS的治疗益处。关于该主题的证据水平较低。
