title: Frameless fractionated stereotactic radiosurgery for vestibular schwannomas: a single-institution experience.
abstract: OBJECTIVE
  To examine tumor control, hearing preservation, and complication rates after frameless fractionated stereotactic radiosurgery (SRS) in patients with vestibular schwannomas (VS).
  
  
  METHODS
  Thirty-seven patients treated with fractionated SRS from 2002 to 2011 were retrospectively analyzed. Ninety-five percent were treated with 25 Gy in five fractions, targeting a median tumor volume of 1.03 cc (range 0.14-7.60).
  
  
  RESULTS
  With a median follow-up of 4.25 years (range, 15 months-9 years), no tumors required an additional treatment resulting in 100% tumor control rate. Radiographic control rate was 91% in 32 patients at a median follow-up of 3 years. Of the 14 patients with serviceable hearing and with audiograms, the hearing preservation rate was 78% at a median follow-up of 18 months. Twenty-six patients with serviceable hearing pretreatment, were evaluated by a phone survey with a hearing preservation rate of 73% at a 5 year median follow-up. There were two cases that developed both new increased trigeminal parasthesias and facial spasms but there were no cases of facial weakness. Patient had 96% of good to excellent satisfaction rate with the treatment at a median follow-up of 5 years.
  
  
  CONCLUSIONS
  Frameless fractionated SRS treatment of VS results in good rate of tumor control. Hearing preservation rate and rates of cranial nerve toxicity are comparable to what is reported in the literature. Patients choose this modality because of its non-invasive nature and are generally very satisfied with their long term outcome.
authors.affiliation: Department of Radiation Medicine, MedStar Georgetown University Hospital Washington, DC, USA.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
authors.forename: Alexander
authors.initials: A
authors.lastname: Tai
authors.forename: Alexis
authors.initials: A
authors.lastname: Strohl
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Steehler
authors.forename: Abdul
authors.initials: A
authors.lastname: Rashid
authors.forename: Gregory
authors.initials: G
authors.lastname: Gagnon
authors.forename: K William
authors.initials: KW
authors.lastname: Harter
authors.forename: Ann K
authors.initials: AK
authors.lastname: Jay
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Kim
authors.forename: Walter
authors.initials: W
authors.lastname: Jean
keywords: SRS; acoustic neuroma; cyberknife; fractionated; radiation; vestibular schwannoma