Hearing Preservation After Upfront Gamma Knife Radiosurgery Versus Initial Conservative Management in Patients With Newly Diagnosed Vestibular Schwannoma: Results From a Prospective Randomized Study.
| Title: | Hearing Preservation After Upfront Gamma Knife Radiosurgery Versus Initial Conservative Management in Patients With Newly Diagnosed Vestibular Schwannoma: Results From a Prospective Randomized Study. |
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| Authors: | Bartek J; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.; Benmakhlouf H; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.; Department of Radiation Oncology, Karolinska University Hospital, Stockholm, Sweden.; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.; Frostell A; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Wangerid T; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Jakola AS; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.; Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.; Al-Saffar Y; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.; Samadi A; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Gubanski M; Department of Radiation Oncology, Karolinska University Hospital, Stockholm, Sweden.; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.; Lippitz B; Interdiziplinären Centrum fur Radiochirurgi iCERA, Hamburg, Germany.; Forshell Hederstierna C; Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.; Förander P; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Department of Medicine, Karolinska Institutet, Stockholm, Sweden. |
| Source: | Neurosurgery [Neurosurgery] 2026 Apr 02. Date of Electronic Publication: 2026 Apr 02. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 7802914 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4040 (Electronic) Linking ISSN: 0148396X NLM ISO Abbreviation: Neurosurgery Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc.; Original Publication: Baltimore, Williams & Wilkins. |
| Abstract: | Background and Objectives: To study the effect on tumor control and serviceable hearing in patients with vestibular schwannoma treated with upfront Gamma Knife Radiosurgery (Upfront GKRS group) compared with patients undergoing initial conservative management (Conservative group).; Methods: Between 2013 and 2017, patients with newly diagnosed Vestibular Schwannoma with a maximum diameter of 20 mm were asked to participate in this single-center, open-label 1:1 randomized clinical trial with parallel group design. Outcomes were assessed by differences in tumor control and hearing preservation at 5-year follow-up between the upfront GKRS group, vs the conservative group, with serviceable hearing defined as Gardner-Robertson class 1-2.; Results: Fifty-two patients with serviceable hearing were included and randomly assigned to upfront GKRS group (n = 24) or conservative group (n = 28). The groups were well-balanced at baseline. At 5-year follow-up, 24 of 24 patients in the upfront GKRS group (12 Gy) had tumor control, with 14 of 28 patients in the conservative group needing active treatment. Sixty-five percent of patients in upfront GKRS group had serviceable hearing compared with 50% in the conservative group (P = .388). No major adverse events were registered in either group for the duration of this study.; Conclusion: The results of this randomized controlled trial demonstrate tumor control after GKRS in newly diagnosed Vestibular Schwannoma, although no significant difference of hearing preservation was observed in upfront GKRS compared with conservative management.; Trial Registration: NCT01938677.; (Copyright © Congress of Neurological Surgeons 2026. All rights reserved.) |
| References: | Chopra R, Kondziolka D, Niranjan A, Lunsford LD, Flickinger JC. Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys. 2007;68(3):845-851.; Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg. 2005;102 Suppl(1):195–199.; Dhayalan D, Tveiten OV, Finnkirk M, et al. Upfront radiosurgery vs a wait-and-scan approach for small- or medium-sized vestibular schwannoma: the V-REX randomized clinical trial. JAMA. 2023;330(5):421-431.; Iwai Y, Yamanaka K, Shiotani M, Uyama T. Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery. 2003;53(2):282-287; discussion 287-8.; Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC. Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med. 1998;339(20):1426-1433.; Regis J, Tamura M, Delsanti C, Roche PH, Pellet W, Thomassin JM. Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery. Prog Neurol Surg. 2008;21:142-151.; Rowe JG, Radatz MW, Walton L, Hampshire A, Seaman S, Kemeny AA. Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas. J Neurol Neurosurg Psychiatry. 2003;74(11):1536-1542.; Tamura M, Carron R, Yomo S, et al. Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery. 2009;64(2):289-296; discussion 296.; Yomo S, Carron R, Thomassin JM, Roche PH, Regis J. Longitudinal analysis of hearing before and after radiosurgery for vestibular schwannoma. J Neurosurg. 2012;117(5):877-885.; Regis J, Carron R, Park MC, et al. Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas. J Neurosurg. 2010;113 Suppl(Special Supplement):105–111.; Myrseth E, Moller P, Pedersen PH, Lund-Johansen M. Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery. 2009;64(4):654-661; discussion 661-3.; Lobato-Polo J, Kondziolka D, Zorro O, Kano H, Flickinger JC, Lunsford LD. Gamma knife radiosurgery in younger patients with vestibular schwannomas. Neurosurgery. 2009;65(2):294-300; discussion 300-1.; Breivik CN, Nilsen RM, Myrseth E, et al. Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life. Neurosurgery. 2013;73(1):48-56; discussion 56-7.; Stangerup SE, Caye-Thomasen P. Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am. 2012;45(2):257-268, vii.; Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol. 1988;97(1):55-66.; van Linge A, van Os R, Hoekstra N, et al. Progression of hearing loss after LINAC-based stereotactic radiotherapy for vestibular schwannoma is associated with cochlear dose, not with pre-treatment hearing level. Radiat Oncol. 2018;13(1):253.; Pollock BE, Driscoll CL, Foote RL, et al. Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery. 2006;59(1):77-85; discussion 77-85.; Wolbers JG, Dallenga AH, Mendez Romero A, van Linge A. What intervention is best practice for vestibular schwannomas? A systematic review of controlled studies. BMJ Open. 2013;3(2):e001345.; Hasegawa T, Kato T, Yamamoto T, et al. Long-term hearing outcomes after gamma knife surgery in patients with vestibular schwannoma with hearing preservation: evaluation in 92 patients with serial audiograms. J Neurooncol. 2018;138(2):283-290.; Bin-Alamer O, Abou-Al-Shaar H, Peker S, et al. Vestibular schwannoma international study of active surveillance versus stereotactic radiosurgery: the VISAS study. Int J Radiat Oncol Biol Phys. 2024;120(2):454-464.; Balossier A, Tuleasca C, Delsanti C, et al. Long-term hearing outcome after radiosurgery for vestibular schwannoma: a systematic review and meta-analysis. Neurosurgery. 2023;92(6):1130-1141.; Breivik CN, Varughese JK, Wentzel-Larsen T, Vassbotn F, Lund-Johansen M. Conservative management of vestibular schwannoma--a prospective cohort study: treatment, symptoms, and quality of life. Neurosurgery. 2012;70(5):1072-1080; discussion 1080. |
| Grant Information: | ALFGBG-965622 ALF, örselforskningsfonden |
| Contributed Indexing: | Keywords: Acoustic neuroma; Gamma Knife radiosurgery; Hearing; Neurosurgery; Outcome; Randomized clinical trial; Vestibular schwannoma; audiometry |
| Molecular Sequence: | ClinicalTrials.gov NCT01938677 |
| Entry Date(s): | Date Created: 20260402 Latest Revision: 20260402 |
| Update Code: | 20260402 |
| DOI: | 10.1227/neu.0000000000004016 |
| PMID: | 41925729 |
| Database: | MEDLINE |
Journal Article