title: Improved trigeminal and facial nerve tolerance following fractionated stereotactic radiotherapy for large acoustic neuromas.
abstract: The purpose of this study was to demonstrate improved cranial nerve tolerance following fractionated stereotactic radiotherapy for large acoustic neuromas, defined as tumours with pons-petrous distance (A) > 1 cm and midporous transverse diameter (A + Y) > 2 cm. Of 28 patients with acoustic neuromas treated with fractionated stereotactic radiotherapy, 19 had large tumours at high risk for radiosurgery-induced cranial neuropathy. Six patients received 36 Gy in six, weekly, fractions and 13 patients received 30 Gy in six, weekly, fractions. 15 patients had evaluable trigeminal nerve function and 16 had evaluable facial nerve function. At a median follow-up of 4.5 years, tumour shrinkage was seen in 10 patients and tumour size was stable in nine. None of the patients developed any evidence of transient, or permanent, trigeminal or facial neuropathy at any time during their follow-up period. Fractionated stereotactic radiotherapy may offer a superior therapeutic ratio to single fraction stereotactic radiosurgery in the management of large acoustic neuromas, as evidenced by the absence of post-treatment trigeminal and facial neuropathy.
authors.affiliation: Department of Radiation Oncology, Temple University School of Medicine, Philadelphia, PA 19140, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Kalapurakal
authors.forename: C L
authors.initials: CL
authors.lastname: Silverman
authors.forename: N
authors.initials: N
authors.lastname: Akhtar
authors.forename: D W
authors.initials: DW
authors.lastname: Andrews
authors.forename: B
authors.initials: B
authors.lastname: Downes
authors.forename: P R
authors.initials: PR
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020209:Cranial Nerve Injuries / Q000517:prevention & control; D019583:Dose Fractionation, Radiation; D005154:Facial Nerve / Q000528:radiation effects*; D006801:Humans; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D011836:Radiation Tolerance; D016634:Radiosurgery; D014276:Trigeminal Nerve / Q000528:radiation effects*