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ISRS Practice Guideline
Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline
May N. Tsao, Arjun Sahgal, Wei Xu, Antonio De Salles, Motohiro Hayashi, Marc Levivier, Lijun Ma, Roberto Martinez, Jean Régis, Sam Ryu, Ben J. Slotman and Ian Paddick

These guidelines should not be considered inclusive of all methods of care or exclusive of other methods or care reasonably directed to obtain similar results. The physician must make the ultimate judgment depending on characteristics and circumstances of individual patients. Adherence to this guideline will not ensure successful treatment in every situation. The authors of this guideline and the International Society of Stereotactic Radiosurgery assume no liability for the information, conclusions and recommendations contained in this report.

Objectives: The aim of this systematic review was to develop International Stereotactic Radiosurgery Society (ISRS) consensus guideline statements for vestibular schwannoma.

Methods: A systematic review of the literature was performed up to April 2015.

Results: A total of 55 full-text articles were included in the analysis. All studies were retrospective, except for 2 prospective quality of life studies. Five-year tumour control rates with Gamma Knife radiosurgery (RS), single fraction linac RS, or fractionated (either hypofractionated or conventional fractionation) stereotactic radiation therapy (FSRT) were similar at 81-100%. The single fraction RS series (linac or Gamma Knife) with tumour marginal doses between 12 and 14 Gy revealed 5-year tumour control rates of 90-99%, hearing preservation rates of 41-79%, facial nerve preservation rates of 95-100% and trigeminal preservation rates of 79-99%.

There were 6 non-randomized studies comparing single fraction RS versus FSRT. There was no statistically significant difference in tumour control; HR=1.66 (95% CI 0.81, 3.42), p =0.17, facial nerve function; HR = 0.67 (95% CI 0.30, 1.49), p =0.33, trigeminal nerve function; HR = 0.80 (95% CI 0.41, 1.56), p =0.51, and hearing preservation; HR = 1.10 (95% CI 0.72, 1.68), p =0.65 comparing single fraction RS with FSRT.

Nine quality of life reports yielded conflicting results as to which modality (surgery, observation, or radiation) was associated with better quality of life outcomes.

Conclusions: There are no randomized trials to help guide management of patients with vestibular schwannoma. Within the limitations of the retrospective series, a number of consensus statements were made.

Keywords: vestibular, acoustic, schwannoma, neuroma, systematic review

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