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

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.

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).

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).

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.