Fractionated radiation therapy in the treatment of stage III and IV cerebello-pontine angle neurinomas: preliminary results in 20 cases.
From January 1986 to March 1989, 20 patients with stage III and IV cerebello-pontine angle neurinomas were treated with external fractionated radiation therapy; seven patients had phacomatosis. Indications for radiation therapy were as follows: (a) poor general condition or old age contraindicating surgery, 10 patients; (b) hearing preservation in bilateral neurinomas after contralateral tumor removal, 5 patients; (c) partial resection or high risk of recurrence after subsequent surgery for relapse, 4 patients; (d) non-surgical relapse, 1 patient. Most patients were irradiated with a 9 MV linear accelerator. A 3 to 4-field technique with 5 x 5 cm portals was used. Doses were calculated on a 95% isodose and were given 5 days a week for a mean total dose of 5140 cGy (180 cGy/fraction). Median follow-up from radiation therapy was 30 months (7 to 46); 4 patients died, 2 with progressive disease. Two patients underwent total tumor removal after radiation therapy (1 stable and 1 growing tumor). On the whole, 14 tumors remained stable, 3 decreased in size, and 3 progressed. CT scan or NMR tumor changes consistent with partial tumor necrosis appeared in four cases. Hearing preservation was obtained in 3/5 hearing patients with phacomatosis. When surgery is not indicated or incomplete, fractionated radiation therapy appears to be an effective and well-tolerated treatment for stage III and IV neurinomas. Hearing can be preserved.
Maire
J P
JP
Service de Radiothérapie, Hôpital Saint-André, Bordeaux, France.
Floquet
A
A
Darrouzet
V
V
Guérin
J
J
Bébéar
J P
JP
Caudry
M
M
D000328:Adult; D000368:Aged; D002528:Cerebellar Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D002530:Cerebellopontine Angle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000453:epidemiology / Q000532:radiotherapy*; D009456:Neurofibromatosis 1 / Q000453:epidemiology / Q000532:radiotherapy*; D009464:Neuroma, Acoustic / Q000453:epidemiology / Q000532:radiotherapy*; D012189:Retrospective Studies