Hollosi Noel-Adrian, Reimers Julie Luise, Santacroce Antonio, Fürweger Christoph, Kufeld Markus, Bruynzeel Anna M E, Verhoeff Joost J C, Muacevic Alexander, Shih Helen A, Ehret Felix
Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
University of Münster, Münster, Germany.
Clin Transl Radiat Oncol. 2025 Jun 4;54:100989. doi: 10.1016/j.ctro.2025.100989. eCollection 2025 Sep.
Stereotactic radiosurgery (SRS) is a widely used treatment modality for vestibular schwannomas due to its non-invasive nature and high tumor control rates. However, some patients experience tumor progression after treatment. In this setting, reirradiation with SRS represents a potential treatment option. This systematic review and meta-analysis evaluates the evidence for reirradiation of vestibular schwannomas with SRS.
This systematic literature review and meta-analysis investigates the efficacy and safety of reirradiation with SRS for vestibular schwannoma and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
A total of 806 studies were screened and 35 included, comprising 394 reirradiated patients. The median time from first treatment to reirradiation was 45 months (range: 12 - 65 months). Reirradiation with SRS, applying a median marginal/prescription dose of 12 Gy, achieved an estimated local control of 95% (95% confidence interval (CI): 92 - 97%, I = 29.62%, p = 0.10). Trigeminal and facial nerve deterioration rates after repeat SRS were 7% (95% CI: 4 - 10%, I = 0.0%, p = 0.44) and 6% (95% CI: 3 - 8%, I = 0.0%, p = 0.53), respectively. Serviceable hearing after reirradiation with SRS was rare (5%, 95% CI: 2 - 8%, I = 0.0%, p = 0.46). Among patients with serviceable hearing before reirradiation, 43% maintained it after treatment (95% CI: 29 - 57%, I = 65.71%, p = 0.00). The risk of bias across all studies was high.
Reirradiation with SRS appears to be a safe and effective salvage treatment for progressive vestibular schwannomas. Prospective studies are warranted to define the optimal dose, timing, and dose constraints for reirradiation.
立体定向放射外科（SRS）因其无创性和高肿瘤控制率，是一种广泛应用于前庭神经鞘瘤的治疗方式。然而，一些患者在治疗后会出现肿瘤进展。在这种情况下，SRS再程放疗是一种潜在的治疗选择。本系统评价和荟萃分析评估了SRS对前庭神经鞘瘤进行再程放疗的证据。
本系统文献综述和荟萃分析研究了SRS对前庭神经鞘瘤再程放疗的有效性和安全性，并按照系统评价和荟萃分析的首选报告项目（PRISMA）进行。
共筛选了806项研究，纳入35项，包括394例接受再程放疗的患者。从首次治疗到再程放疗的中位时间为45个月（范围：12 - 65个月）。SRS再程放疗的中位边缘/处方剂量为12 Gy，估计局部控制率为95%（95%置信区间（CI）：92 - 97%，I² = 29.62%，p = 0.10）。重复SRS后三叉神经和面神经恶化率分别为7%（95% CI：4 - 10%，I² = 0.0%，p = 0.44）和6%（95% CI：3 - 8%，I² = 0.0%，p = 0.53）。SRS再程放疗后仍保留有用听力的情况很少见（5%，95% CI：2 - 8%，I² = 0.0%，p = 0.46）。在再程放疗前有有用听力的患者中，43%在治疗后仍保留（95% CI：29 - 57%，I² = 65.71%，p = 0.00）。所有研究的偏倚风险都很高。
SRS再程放疗似乎是进行性前庭神经鞘瘤安全有效的挽救性治疗方法。有必要开展前瞻性研究以确定再程放疗的最佳剂量、时机和剂量限制。
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