The role of stereotactic radiosurgery in the management of vestibular schwannoma in octogenarians: an international multi-institutional study.

Abstract

The incidence of vestibular schwannoma (VS) diagnosis among octogenarians has increased due to longer life expectancy and greater MRI accessibility and utilization. Stereotactic radiosurgery (SRS) offers a safe management strategy for these patients. The authors retrospectively analyzed the data of octogenarians with VS managed with SRS across 27 institutions, assessing clinical and audiological outcomes, including survival rates, tumor control responses, complications, and posttreatment functional outcomes. Among 309 octogenarians with VS managed with single-fraction SRS, overall survival was 97.8% at 1 year, 88.5% at 3 years, and 78.1% at 5 years; the corresponding progression-free survival rates were 95.8%, 81.1%, and 71.1%, respectively. In competing risk analysis, tumor progression occurred in 5.2% of patients by 5 years, whereas death without progression reached 19.8%. Tumor control was achieved in 94.8% at 3 and 5 years. At last imaging follow-up (median 33.5 months, IQR 14-60 months), 29.1% showed volume regression. Communicating hydrocephalus developed in 4.2% and was successfully managed with CSF diversion. Age, sex, tumor volume, Koos grade, and margin dose were not significant predictors of patient survival or tumor progression. Single-fraction SRS is a safe and effective management modality for octogenarians with VS, providing durable tumor control with minimal morbidity.