Radiotherapy for Vestibular Schwannoma: Retrospective Cohort and Propensity Score Matching Analysis

Vinicius de Carvalho Gico; Geovanne Pedro Mauro; Leila Maria Da Roz; Eduardo Weltman; Evandro Cesar De Souza; Rosangela Correa Villar; Eberval Gadelha Figueiredo; Carlos Gilberto Carlotti

doi:10.1055/a-2620-0288

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Radiotherapy for Vestibular Schwannoma: Retrospective Cohort and Propensity Score Matching Analysis

Journal article

Peer reviewed

Radiotherapy for Vestibular Schwannoma: Retrospective Cohort and Propensity Score Matching Analysis

Vinicius de Carvalho Gico, Geovanne Pedro Mauro, Leila Maria Da Roz, Eduardo Weltman, Evandro Cesar De Souza, Rosangela Correa Villar, Eberval Gadelha Figueiredo and Carlos Gilberto Carlotti

Journal of neurological surgery. Part B, Skull base, Vol.87(3), pp.256-263

06/2026

DOI: 10.1055/a-2620-0288

PMCID: PMC13143385

PMID: 42095039

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Abstract

Background Surgery and stereotactic radiotherapy (SRT) are widely used for treating vestibular schwannomas (VS), but the impact of different SRT regimens remains debated. This study assesses outcomes of various SRT techniques in a large cohort. Materials and Methods Retrospective cohort of consecutive patients treated in a large academic hospital between 2008 and 2024. All patients were treated with LINAC-based SRT. The study compared outcomes between single-dose SRS (12-15 Gy), five-fraction SRS (total of 25 Gy), and conventionally fractionated SRT (50.4 Gy in 28 fractions). The main outcome was progression-free survival (PFS). Results The cohort included 197 patients, with a median age of 50.2 years, 65.5% of whom were female. The mean lesion size was 2.4 cm, and 61.4% of lesions were classified as high-class Koos (III and IV). Median follow-up was 54.0 months (6-142.1). Overall lesion control was 89.8% by RECIST 1.1 criteria, with no significant difference in PFS between the groups after propensity score matching. New hearing loss occurred in 14.7% of patients, whereas new facial palsy was reported in 3.0%. The presence of type-2 neurofibromatosis (NF2) was associated with poorer PFS (50.4 vs. 46.6 months, p = 0.002). Propensity score matching analysis was done and all regimens had similar PFS (matched sample size was 193, p = 0.808). Conclusion Different SRT regimens showed similar outcomes for lesion control and toxicity in VS patients, including those with NF2. This study supports LINAC-based SRT as a flexible treatment option, although further prospective studies are needed.

Surgery

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Science & Technology

Details

Title: Subtitle: Radiotherapy for Vestibular Schwannoma: Retrospective Cohort and Propensity Score Matching Analysis
Creators: Vinicius de Carvalho Gico - Univ Sao Paulo, Med Sch, Dept Radiat Oncol, Inst Canc Estado Sao Paulo, Sao Paulo, SP, Brazil
Geovanne Pedro Mauro - Universidade de São Paulo
Leila Maria Da Roz - Universidade de São Paulo
Eduardo Weltman - Universidade de São Paulo
Evandro Cesar De Souza - Universidade de São Paulo
Rosangela Correa Villar - Universidade de São Paulo
Eberval Gadelha Figueiredo - Universidade de São Paulo
Carlos Gilberto Carlotti - Universidade de São Paulo
Resource Type: Journal article
Publication Details: Journal of neurological surgery. Part B, Skull base, Vol.87(3), pp.256-263
DOI: 10.1055/a-2620-0288
PMID: 42095039
PMCID: PMC13143385
NLM abbreviation: J Neurol Surg B Skull Base
ISSN: 2193-6331
eISSN: 2193-634X
Publisher: Thieme Medical Publishers
Number of pages: 8
Language: English
Electronic publication date: 06/10/2025
Date published: 06/2026
Academic Unit: Radiation Oncology
Record Identifier: 9984914151002771

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