Surgical monotherapy in vestibular schwannoma: The impact of distinct extent of resection grades on long-term tumor control parameters
Residual tumor after vestibular schwannoma (VS) resection has been associated with higher incidence of recurrence. However, the definition of residual tumor is very heterogenous. Subtotal resection (STR) is most frequently used on its own, only seldom near-total-resection (NTR) and decompressive surgery (DS) is added to the extent of resection classification. This study aims to analyze clinical tumor control parameters in NTR, STR, DS and gross total resection (GTR).
This is a retrospective cohort study of solitary VS patients treated with microsurgical resection by retrosigmoid resection between 2005 and 2012. Patients were contacted 10 years after surgery report on radiographic tumor control by gadolinium-contrast-enhanced magnetic resonance imaging (MRI). Patients and tumor characteristics were collected retrospectively.
N=426 patients met the inclusion criteria and were included in this analysis. Overall, the rate of GTR was 94%, with 3% NTR and 3% STR. Mean time of follow-up was 5.6 years. 100% patients of Koos I were managed by GTR. In Koos II 1% received NTR, and none received STR. In Koos III 2% received STR and 3% received NTR. The highest rate of STR was present in Koos IV with 6% STR and 2% NTR. In GTR, the long-term recurrence rate was 5%, which was significantly lower compared in NTR (16%) and STR (54%). The recurrent event per one million patient days was 16 in GTR, 62 in NTR and 130 in STR. The median time to recurrence was the longest in NTR (7.2 years) and GTR (6.2 years), compared to STR (5.6 years).
The rate of STR and NTR rose with tumor size. The rate of recurrent events was significantly more frequent in STR and NTR. However, there is a difference in time to recurrence and frequency of recurrent events between NTR and STR themselves – therefore a more detailed classification in EOR of VS should be put forward to differentiate these clearly different patient groups with different postoperative oncological behavior. This would also benefit the current discussion on, which patient should be treated with adjuvant radiosurgery after sub- and or near-total resection. Follow-Up should be longer then 5 years to uncover the true rate of recurrence after surgical resection in VS.
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