title: Fractionated stereotactic radiotherapy for acoustic neuromas: long-term outcomes.
abstract: OBJECTIVE
  Acoustic neuromas are rare, benign intracranial tumours. There are a variety of treatment options, with no clear optimal management strategy and wide variation in treated outcomes. We report the outcomes from a 15 year cohort of patients treated at our centre using fractionated stereotactic radiotherapy (52.5 Gy in 25 fractions).
  
  
  METHODS
  We analysed a retrospective case series. Patients were identified from patient records and a retrospective review of case notes and imaging reports was undertaken. We assessed tumour response using RECIST criteria and recorded toxicity. Progression-free survival was estimated using the Kaplan-Meier method. The study was conducted according to the STROBE guidelines.
  
  
  RESULTS
  In total, 93 patients were identified; 83 patients had follow-up data, with a median follow-up period of 5.7 years. The overall control rate using RECIST criteria was 92%. Data on complications were available for 90 patients, with six (7%) experiencing a reduction in hearing, one (1%) developing trigeminal nerve dysfunction and one (1%) a deterioration in facial nerve function. Other toxicities included four (4%) patients who developed hydrocephalus, requiring the placement of a shunt and one (1%) patient who developed radiation brainstem necrosis. After further evaluation this patient was deemed to have been treated within acceptable dose constraints.
  
  
  CONCLUSIONS
  These data suggest that a good control rate of acoustic neuromas is achievable using fractionated stereotactic radiotherapy to a dose of 52.5 Gy in 25 fractions. Toxicity is considered acceptable but the episode of radiation brainstem necrosis remains of concern and is the subject of further work.
authors: Department of Oncology, Royal Free Hospital, London, UK. Electronic address: dwoolf@doctors.org.uk.
authors: D K
authors: DK
authors: Woolf
authors: M
authors: M
authors: Williams
authors: C L
authors: CL
authors: Goh
authors: D R
authors: DR
authors: Henderson
authors: R V
authors: RV
authors: Menashy
authors: N
authors: N
authors: Simpson
authors: B
authors: B
authors: Mastroianni
authors: C H
authors: CH
authors: Collis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acoustic neuroma; outcomes; radio-necrosis; stereotactic radiotherapy; vestibular Schwannoma