Mantegh Sethi, Shravan Gowrishankar, James Tysome, Neil Donnelly, Patrick Axon, Manohar Bance, Richard Mannion, Mathew Guilfoyle, Juliette Buttimore, Nicola Gamazo, Simon Duke, Raj Jena, Katherine Burton, Sarah Jefferies, Umberto Fornezza, Zeno Perini, Cristina Mari, Luca Gazzola, Sammy Schouten, Inge Compter, Daniëlle B P Eekers, Henricus P M Kunst, Rohan Bassi, Samuel MacKeith, Sanjeeva Jeyaretna, Gillian Whitfield, Catherine McBain, Rovel Colaco, Angus Hotchkies, Simon Lloyd, Rupert Obholzer, Ya Fang Amanda Cheang, Nick Thomas, Sinan Barazi, Eleni Maratos, Jonathan Shapey, Sheila Hassan, Kazumi Chia, Cornel Tancu, Neil Kitchen, John P Marinelli, Matthew L Carlson, Michael J Link, Daniele Borsetto
{"title":"生长的前庭神经鞘瘤的放射治疗。","authors":"Mantegh Sethi, Shravan Gowrishankar, James Tysome, Neil Donnelly, Patrick Axon, Manohar Bance, Richard Mannion, Mathew Guilfoyle, Juliette Buttimore, Nicola Gamazo, Simon Duke, Raj Jena, Katherine Burton, Sarah Jefferies, Umberto Fornezza, Zeno Perini, Cristina Mari, Luca Gazzola, Sammy Schouten, Inge Compter, Daniëlle B P Eekers, Henricus P M Kunst, Rohan Bassi, Samuel MacKeith, Sanjeeva Jeyaretna, Gillian Whitfield, Catherine McBain, Rovel Colaco, Angus Hotchkies, Simon Lloyd, Rupert Obholzer, Ya Fang Amanda Cheang, Nick Thomas, Sinan Barazi, Eleni Maratos, Jonathan Shapey, Sheila Hassan, Kazumi Chia, Cornel Tancu, Neil Kitchen, John P Marinelli, Matthew L Carlson, Michael J Link, Daniele Borsetto","doi":"10.1001/jamaoto.2025.1953","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>In the literature, there is a lack of data reporting tumor control rates after radiotherapy in actively growing vestibular schwannomas (VS). Data for this rarely studied population are needed.</p><p><strong>Objective: </strong>To estimate tumor control rates in radiologically growing VS treated with first-line radiotherapy.</p><p><strong>Design, setting, and participants: </strong>This international, multicenter cohort study used prospectively collected data from patients with growing unilateral VS treated first-line with radiotherapy between January 2000 and December 2023 from 8 tertiary referral skull base units. The data were analyzed in June 2025.</p><p><strong>Exposures: </strong>Radiotherapy as an initial treatment for VS.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was treatment failure, ie VS growth postradiotherapy, which was predefined as an increase in maximum intracranial tumor diameter (ICTD) of 3 mm or greater within the first 2 years after radiotherapy or 2 mm or greater thereafter. Secondary outcomes were treatment failure based on different definitions of VS growth: (1) an increase in ICTD of 2 mm or greater, (2) an increase in ICTD of 3 mm or greater, and (3) conversion to surgery.</p><p><strong>Results: </strong>A total of 1883 patients (975 female individuals [51.8%]; median age at diagnosis, 63 years [IQR, 53-71 years]) were included in the study. Using the primary definition of treatment failure (an increase in ICTD of ≥3 mm within the first 2 years postradiotherapy or ≥2 mm thereafter), the Kaplan-Meier estimate yielded a 10-year tumor control rate of 76.1% (95% CI, 72.7%-79.2%). For secondary outcome definitions, 10-year tumor control rates were 60.1% (95% CI, 57.5%-64.3%) for an ICTD increase of 2 mm or greater, 78.3% (95% CI, 75.0%-81.2%) for an increase of 3 mm or greater, and 92.6% (95% CI, 90.4%-94.3%) for conversion to surgery. Neither pretreatment tumor size nor tumor location (intracanalicular vs extracanalicular) were significantly associated with treatment failure.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study provide tumor control outcomes for radiologically growing VS treated with radiotherapy using several clinically relevant definitions of growth. By focusing exclusively on this rarely isolated subgroup, the findings offer targeted data to potentially inform treatment expectations and future research.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412036/pdf/","citationCount":"0","resultStr":"{\"title\":\"Radiotherapy for Growing Vestibular Schwannomas.\",\"authors\":\"Mantegh Sethi, Shravan Gowrishankar, James Tysome, Neil Donnelly, Patrick Axon, Manohar Bance, Richard Mannion, Mathew Guilfoyle, Juliette Buttimore, Nicola Gamazo, Simon Duke, Raj Jena, Katherine Burton, Sarah Jefferies, Umberto Fornezza, Zeno Perini, Cristina Mari, Luca Gazzola, Sammy Schouten, Inge Compter, Daniëlle B P Eekers, Henricus P M Kunst, Rohan Bassi, Samuel MacKeith, Sanjeeva Jeyaretna, Gillian Whitfield, Catherine McBain, Rovel Colaco, Angus Hotchkies, Simon Lloyd, Rupert Obholzer, Ya Fang Amanda Cheang, Nick Thomas, Sinan Barazi, Eleni Maratos, Jonathan Shapey, Sheila Hassan, Kazumi Chia, Cornel Tancu, Neil Kitchen, John P Marinelli, Matthew L Carlson, Michael J Link, Daniele Borsetto\",\"doi\":\"10.1001/jamaoto.2025.1953\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>In the literature, there is a lack of data reporting tumor control rates after radiotherapy in actively growing vestibular schwannomas (VS). Data for this rarely studied population are needed.</p><p><strong>Objective: </strong>To estimate tumor control rates in radiologically growing VS treated with first-line radiotherapy.</p><p><strong>Design, setting, and participants: </strong>This international, multicenter cohort study used prospectively collected data from patients with growing unilateral VS treated first-line with radiotherapy between January 2000 and December 2023 from 8 tertiary referral skull base units. The data were analyzed in June 2025.</p><p><strong>Exposures: </strong>Radiotherapy as an initial treatment for VS.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was treatment failure, ie VS growth postradiotherapy, which was predefined as an increase in maximum intracranial tumor diameter (ICTD) of 3 mm or greater within the first 2 years after radiotherapy or 2 mm or greater thereafter. Secondary outcomes were treatment failure based on different definitions of VS growth: (1) an increase in ICTD of 2 mm or greater, (2) an increase in ICTD of 3 mm or greater, and (3) conversion to surgery.</p><p><strong>Results: </strong>A total of 1883 patients (975 female individuals [51.8%]; median age at diagnosis, 63 years [IQR, 53-71 years]) were included in the study. Using the primary definition of treatment failure (an increase in ICTD of ≥3 mm within the first 2 years postradiotherapy or ≥2 mm thereafter), the Kaplan-Meier estimate yielded a 10-year tumor control rate of 76.1% (95% CI, 72.7%-79.2%). For secondary outcome definitions, 10-year tumor control rates were 60.1% (95% CI, 57.5%-64.3%) for an ICTD increase of 2 mm or greater, 78.3% (95% CI, 75.0%-81.2%) for an increase of 3 mm or greater, and 92.6% (95% CI, 90.4%-94.3%) for conversion to surgery. Neither pretreatment tumor size nor tumor location (intracanalicular vs extracanalicular) were significantly associated with treatment failure.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study provide tumor control outcomes for radiologically growing VS treated with radiotherapy using several clinically relevant definitions of growth. By focusing exclusively on this rarely isolated subgroup, the findings offer targeted data to potentially inform treatment expectations and future research.</p>\",\"PeriodicalId\":14632,\"journal\":{\"name\":\"JAMA otolaryngology-- head & neck surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2025-09-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412036/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMA otolaryngology-- head & neck surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1001/jamaoto.2025.1953\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA otolaryngology-- head & neck surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamaoto.2025.1953","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
Importance: In the literature, there is a lack of data reporting tumor control rates after radiotherapy in actively growing vestibular schwannomas (VS). Data for this rarely studied population are needed.
Objective: To estimate tumor control rates in radiologically growing VS treated with first-line radiotherapy.
Design, setting, and participants: This international, multicenter cohort study used prospectively collected data from patients with growing unilateral VS treated first-line with radiotherapy between January 2000 and December 2023 from 8 tertiary referral skull base units. The data were analyzed in June 2025.
Exposures: Radiotherapy as an initial treatment for VS.
Main outcomes and measures: The primary outcome was treatment failure, ie VS growth postradiotherapy, which was predefined as an increase in maximum intracranial tumor diameter (ICTD) of 3 mm or greater within the first 2 years after radiotherapy or 2 mm or greater thereafter. Secondary outcomes were treatment failure based on different definitions of VS growth: (1) an increase in ICTD of 2 mm or greater, (2) an increase in ICTD of 3 mm or greater, and (3) conversion to surgery.
Results: A total of 1883 patients (975 female individuals [51.8%]; median age at diagnosis, 63 years [IQR, 53-71 years]) were included in the study. Using the primary definition of treatment failure (an increase in ICTD of ≥3 mm within the first 2 years postradiotherapy or ≥2 mm thereafter), the Kaplan-Meier estimate yielded a 10-year tumor control rate of 76.1% (95% CI, 72.7%-79.2%). For secondary outcome definitions, 10-year tumor control rates were 60.1% (95% CI, 57.5%-64.3%) for an ICTD increase of 2 mm or greater, 78.3% (95% CI, 75.0%-81.2%) for an increase of 3 mm or greater, and 92.6% (95% CI, 90.4%-94.3%) for conversion to surgery. Neither pretreatment tumor size nor tumor location (intracanalicular vs extracanalicular) were significantly associated with treatment failure.
Conclusions and relevance: The results of this cohort study provide tumor control outcomes for radiologically growing VS treated with radiotherapy using several clinically relevant definitions of growth. By focusing exclusively on this rarely isolated subgroup, the findings offer targeted data to potentially inform treatment expectations and future research.
期刊介绍：
JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
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