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Targeted radiation of benign tumors of the vestibular nerve offers some advantages

Press releases may be edited for formatting or style | October 26, 2021 Rad Oncology
Stereotactic radiosurgery (SRS) for benign tumours of the vestibular nerve (vestibular schwannomas, also called acoustic neuromas) offers more advantages to affected patients than microsurgical resection: After targeted one-time and high-dose radiation, facial palsy, hearing loss, and hospitalizations occur less often than after surgery. However, because of the short duration of the studies available, it is unclear whether and to what extent these advantages last, particularly with regard to hearing loss. Moreover, data on serious complications are lacking.

When balancing the benefits and harms of the study results available, overall the data provide a hint of a greater benefit of SRS versus microsurgical resection in patients with vestibular schwannomas needing treatment. This is the conclusion of a benefit assessment conducted by the Institute for Quality and Efficiency in Health Care (IQWiG) on behalf of the Federal Joint Committee (G-BA), which has now been completed.

One-time radiation as an alternative to surgery

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Vestibular schwannomas are benign, usually slow-growing tumours originating from the vestibular nerve and mostly occurring unilaterally in people older than 50 years of age. The consequences often include hearing loss, tinnitus, dizziness and facial palsy. The size, location and growth of the tumour affect the decision on treatment, as do the patient's medical history and preferences.

Especially in the case of small, non-growing tumours not yet causing symptoms, watchful waiting is an option, but requires regular magnetic resonance imaging about every twelve months. In the case of clear symptoms and/or larger tumours, surgery is usually performed. Radiation is an option for older patients with vestibular schwannoma needing treatment and in patients with an increased surgical risk: In single-stage SRS, the tumour tissue in the head is radiated once, with high doses and precision, using linear accelerators or cobalt-60-gamma radiation sources. Because SRS can generally be performed on an outpatient basis, there is usually no need to hospitalize patients.

Advantages of SRS for facial palsy, hearing loss and hospitalizations
A total of three non-randomized prospective comparative studies with approximately two years of follow-up provided results on patient-relevant outcomes. However, serious complications were not recorded in these studies. There were no advantages of SRS versus microsurgical resection for outcomes such as mortality, symptoms (e.g. dizziness, headache, tinnitus and balance disorders), consequences of the disease (e.g. inability to work) or side effects (treatment-related complications and re-interventions) and health-related quality of life.

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