Fractionated Stereotactic Radiotherapy Compared to Stereotactic Radiosurgery for Vestibular Schwannoma in Patients with Type 2 Neurofibromatosis.

BACKGROUND:The use of radiotherapy (RT) for the treatment of vestibulocochlear schwannomas is standard in patients with type 2 neurofibromatosis (NF2). In the general population, fractionated RT (FRT) can achieve good results compared to single-dose radiosurgery (SRS). We aimed to assess whether this is true for NF2 patients as well. METHODS:This retrospective cohort study included 34 patients and 54 lesions treated between 2010 and 2023 in a single university hospital. RESULTS:Thirty-four patient charts were assessed. The median follow-up was 62.6 months (range, 7.1-135.8 months). Lesion size (median larger diameter, 2.5 cm) was correlated with the use of FRT (P > 0.001). Younger age also was correlated with FRT (P = 0.006). Median overall survival and progression-free survival (PFS) were not reached. The overall control rate was 76.5%, and the mean PFS was 49.8 months, compared with . 90.5% and 57.2 months, respectively, for SRS and 66.7% and 44.9 months, respectively, for FRT. There were no differences between the 2 groups in hearing loss, tinnitus, and facial palsy. CONCLUSIONS:In the NF2 population, FRT may yield worse control rates than SRS. Whenever possible, it is preferable to not fractionate treatment for these patients. Nevertheless, the FRT results were still good. More and larger prospective trials are warranted.