TY - JOUR
T1 - Stereotactic Radiosurgery for Vestibular Schwannomas
T2 - Tumor Control Probability Analyses and Recommended Reporting Standards
AU - Soltys, Scott G.
AU - Milano, Michael T.
AU - Xue, Jinyu
AU - Tomé, Wolfgang A.
AU - Yorke, Ellen
AU - Sheehan, Jason
AU - Ding, George X.
AU - Kirkpatrick, John P.
AU - Ma, Lijun
AU - Sahgal, Arjun
AU - Solberg, Timothy
AU - Adler, John
AU - Grimm, Jimm
AU - El Naqa, Issam
N1 - Funding Information:
I.E.N. is on the scientific advisory board of Endectra and receives grants from the National Institutes of Health. Disclosures: S.G.S. is a consultant for iInovio Pharmaceuticals, Inc., receives speaker honoraria from Zap Surgical, Inc., and receives research funding from Novocure. M.T.M. receives royalties from Wolters Kluwer and personal fees from Galera Therapeutics. W.A.T. receives grants from Accuray, Chrysalis, the National Institutes of Health, and Varian; receives honoraria from Accuray, Chrysalis, and Varian Inc.; serves on the scientific advisory board for Archeus; and receives royalties for patent/license/fees/copyright from Wisconsin Alumni Research. E.Y. receives support from National Institutes of Health grant P30 CA008748. J.K. receives grant support from Varian Medical Systems and is a partial owner of ClearSight RT Products. A.S. is an advisor/consultant with AbbVie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); is a board member of International Stereotactic Radiosurgery Society (ISRS); is a Co-Chair for AO Spine Knowledge Forum Tumor; presented past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), BrainLAB, and Medtronic Kyphon; receives research grant from Elekta AB; receives travel accommodations/expenses from Elekta, Varian, and BrainLAB; A.S. also belongs to the Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases, and Linac Based SRS Consortia. J.R.A. is an employee of Zap Surgical, Inc. J.G. receives research grants from Accuray and NovoCure and has a dose volume histograms evaluator patent.
Funding Information:
Disclosures: S.G.S. is a consultant for iInovio Pharmaceuticals, Inc., receives speaker honoraria from Zap Surgical, Inc., and receives research funding from Novocure. M.T.M. receives royalties from Wolters Kluwer and personal fees from Galera Therapeutics. W.A.T. receives grants from Accuray, Chrysalis, the National Institutes of Health, and Varian; receives honoraria from Accuray, Chrysalis, and Varian Inc.; serves on the scientific advisory board for Archeus; and receives royalties for patent/license/fees/copyright from Wisconsin Alumni Research. E.Y. receives support from National Institutes of Health grant P30 CA008748. J.K. receives grant support from Varian Medical Systems and is a partial owner of ClearSight RT Products. A.S. is an advisor/consultant with AbbVie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); is a board member of International Stereotactic Radiosurgery Society (ISRS); is a Co-Chair for AO Spine Knowledge Forum Tumor; presented past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), BrainLAB, and Medtronic Kyphon; receives research grant from Elekta AB; receives travel accommodations/expenses from Elekta, Varian, and BrainLAB; A.S. also belongs to the Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases, and Linac Based SRS Consortia. J.R.A. is an employee of Zap Surgical, Inc. J.G. receives research grants from Accuray and NovoCure and has a dose volume histograms evaluator patent.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Purpose: We sought to investigate the tumor control probability (TCP) of vestibular schwannomas after single-fraction stereotactic radiosurgery (SRS) or hypofractionated SRS over 2 to 5 fractions (fSRS). Methods and Materials: Studies (PubMed indexed from 1993-2017) were eligible for data extraction if they contained dosimetric details of SRS/fSRS correlated with local tumor control. The rate of tumor control at 5 years (or at 3 years if 5-year data were not available) were collated. Poisson modeling estimated the TCP per equivalent dose in 2 Gy per fraction (EQD2) and in 1, 3, and 5 fractions. Results: Data were extracted from 35 publications containing a total of 5162 patients. TCP modeling was limited by the absence of analyzable data of <11 Gy in a single-fraction, variability in definition of “tumor control,” and by lack of significant increase in TCP for doses >12 Gy. Using linear-quadratic–based dose conversion, the 3- to 5-year TCP was estimated at 95% at an EQD2 of 25 Gy, corresponding to 1-, 3-, and 5-fraction doses of 13.8 Gy, 19.2 Gy, and 21.5 Gy, respectively. Single-fraction doses of 10 Gy, 11 Gy, 12 Gy, and 13 Gy predicted a TCP of 85.0%, 88.4%, 91.2%, and 93.5%, respectively. For fSRS, 18 Gy in 3 fractions (EQD2 of 23.0 Gy) and 25 Gy in 5 fractions (EQD2 of 30.2 Gy) corresponded to TCP of 93.6% and 97.2%. Overall, the quality of dosimetric reporting was poor; recommended reporting guidelines are presented. Conclusions: With current typical SRS doses of 12 Gy in 1 fraction, 18 Gy in 3 fractions, and 25 Gy in 5 fractions, 3- to 5-year TCP exceeds 91%. To improve pooled data analyses to optimize treatment outcomes for patients with vestibular schwannoma, future reports of SRS should include complete dosimetric details with well-defined tumor control and toxicity endpoints.
AB - Purpose: We sought to investigate the tumor control probability (TCP) of vestibular schwannomas after single-fraction stereotactic radiosurgery (SRS) or hypofractionated SRS over 2 to 5 fractions (fSRS). Methods and Materials: Studies (PubMed indexed from 1993-2017) were eligible for data extraction if they contained dosimetric details of SRS/fSRS correlated with local tumor control. The rate of tumor control at 5 years (or at 3 years if 5-year data were not available) were collated. Poisson modeling estimated the TCP per equivalent dose in 2 Gy per fraction (EQD2) and in 1, 3, and 5 fractions. Results: Data were extracted from 35 publications containing a total of 5162 patients. TCP modeling was limited by the absence of analyzable data of <11 Gy in a single-fraction, variability in definition of “tumor control,” and by lack of significant increase in TCP for doses >12 Gy. Using linear-quadratic–based dose conversion, the 3- to 5-year TCP was estimated at 95% at an EQD2 of 25 Gy, corresponding to 1-, 3-, and 5-fraction doses of 13.8 Gy, 19.2 Gy, and 21.5 Gy, respectively. Single-fraction doses of 10 Gy, 11 Gy, 12 Gy, and 13 Gy predicted a TCP of 85.0%, 88.4%, 91.2%, and 93.5%, respectively. For fSRS, 18 Gy in 3 fractions (EQD2 of 23.0 Gy) and 25 Gy in 5 fractions (EQD2 of 30.2 Gy) corresponded to TCP of 93.6% and 97.2%. Overall, the quality of dosimetric reporting was poor; recommended reporting guidelines are presented. Conclusions: With current typical SRS doses of 12 Gy in 1 fraction, 18 Gy in 3 fractions, and 25 Gy in 5 fractions, 3- to 5-year TCP exceeds 91%. To improve pooled data analyses to optimize treatment outcomes for patients with vestibular schwannoma, future reports of SRS should include complete dosimetric details with well-defined tumor control and toxicity endpoints.
UR - http://www.scopus.com/inward/record.url?scp=85098497541&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85098497541&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2020.11.019
DO - 10.1016/j.ijrobp.2020.11.019
M3 - Article
C2 - 33375955
AN - SCOPUS:85098497541
SN - 0360-3016
VL - 110
SP - 100
EP - 111
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 1
ER -
