title: Fractionated stereotactic radiotherapy for the treatment of vestibular schwannomas: combined experience of the Toronto-Sunnybrook Regional Cancer Centre and the Princess Margaret Hospital.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of fractionated stereotactic radiotherapy (FSRT) for vestibular schwannomas in patients treated at two university-affiliated hospitals.
  
  
  METHODS
  Thirty-nine patients were treated between April 1996 and September 2000. The median age was 56 years (range: 29-80), and median maximal tumor diameter was 20 mm (range: 9-40). A total of 11 patients had fifth and/or seventh cranial nerve dysfunction before irradiation; 2 patients had only facial weakness, 5 patients had only facial numbness, and 4 patients had both facial weakness and numbness. Thirty-three patients were treated with primary FSRT, and 6 patients were treated for recurrent or persistent disease after previous surgery. All patients were treated with 6-MV photons using a stereotactic system with a relocatable frame. The 39 patients received 50 Gy in 25 fractions over 5 weeks. Median follow-up was 21.8 months (range: 4.4-49.6).
  
  
  RESULTS
  Local control was achieved in 37 patients (95%). Two patients experienced deterioration of their symptoms at 3 and 20 months as a result of clinical progression in one case and tumor progression in the other and underwent surgery post FSRT. A total of 19/28 (67.9%) patients preserved serviceable hearing after FSRT. Deterioration of the facial and trigeminal nerves was observed in only 2 patients who were treated with surgery post FSRT.
  
  
  CONCLUSIONS
  FSRT provided excellent tumor control with minimal morbidity and good hearing preservation in this cohort of patients. Longer follow-up is required to confirm long-term control rates.
authors.affiliation: Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada. ewa.szumacher@tsrcc.on.ca
authors.forename: Ewa
authors.initials: E
authors.lastname: Szumacher
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schwartz
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.forename: Satish
authors.initials: S
authors.lastname: Jaywant
authors.forename: Edmee
authors.initials: E
authors.lastname: Franssen
authors.forename: C Shun
authors.initials: CS
authors.lastname: Wong
authors.forename: Ramani
authors.initials: R
authors.lastname: Ramaseshan
authors.forename: Alex W
authors.initials: AW
authors.lastname: Lightstone
authors.forename: Howard
authors.initials: H
authors.lastname: Michaels
authors.forename: Charles
authors.initials: C
authors.lastname: Hayter
authors.forename: Norm J
authors.initials: NJ
authors.lastname: Laperriere
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery*; D010315:Particle Accelerators; D017785:Photons; D016634:Radiosurgery / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome