Stereotactic Radiosurgery Proves Effective for Early-Stage Vestibular Schwannomas

For patients with Koos grade I vestibular schwannomas, stereotactic radiosurgery (SRS) provides a reliable option for tumor control, outperforming the "watch and wait" approach by a significant margin. A recent international study, known as the VISAS-K1 study, sheds light on the benefits of early SRS intervention for these small, typically asymptomatic tumors, suggesting a potential shift in treatment guidelines.

Improved Tumor Control with SRS

According to the multicenter retrospective study, which reviewed cases across multiple countries, SRS achieved an impressive 99% tumor control rate at three, five, and eight years, compared to substantially lower rates in the observation group (63%, 50%, and 33%, respectively). This difference underscores SRS's potential as a primary treatment for maintaining long-term tumor stability and limiting the progression of vestibular schwannomas, even in asymptomatic patients. The findings come from data on 261 patients, of whom 182 received SRS and 79 were under observation. The SRS-treated patients experienced nearly universal tumor control, with only one reported case of progression.

Reducing Neurological Risks

Beyond tumor control, SRS also demonstrated protective effects against neurological decline. Compared to observation, SRS was associated with a 54% lower risk of tinnitus, an 83% lower risk of vestibular dysfunction, and a 51% reduction in cranial nerve deterioration. These findings suggest that SRS may not only control tumor growth but also preemptively mitigate the onset of neurologic complications associated with vestibular schwannomas. Dr. Jason P. Sheehan, lead researcher, emphasized that once neurological symptoms emerge, they may become irreversible, even if tumor growth is later managed by SRS.

Implications for Patient Management

This study could influence treatment strategies for vestibular schwannomas, with a stronger argument for early SRS intervention, even for smaller, asymptomatic tumors. While "watch and wait" remains a viable strategy for specific patients, these findings highlight the potential benefits of early intervention in preventing long-term neurological issues. For healthcare providers managing vestibular schwannomas, these findings support SRS as a compelling alternative, balancing effective tumor control with the preservation of neurological function.

As clinical guidelines evolve, this evidence positions SRS as a robust option that could benefit a broader range of patients than previously considered.