ArticleNeuro-oncology advances
A volume-conformity paradoxon: Volumetric determinants of treatment success/failure following stereotactic radiosurgery in vestibular schwannoma.
Article in Neuro-oncology advances. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Stereotactic radiosurgery (SRS) is an established, minimally invasive treatment for vestibular schwannoma (VS). However, tumor control rates vary, and predictors of treatment failure remain debated. This study examines whether pre-treatment tumor volume (TV) predicts SRS outcome and explores the relationship between tumor size, Paddick Conformity Index (PCI), and long-term control. Methods: We retrospectively analyzed 928 consecutive patients with solitary VS treated using Gamma Knife radiosurgery. Patients with <2 years of radiographic follow-up were excluded to avoid pseudoprogression. Tumor size was classified using the Koos system, and volumetric measurements were obtained via gadolinium-enhanced magnetic resonance imaging. Treatment failure was defined as sustained volumetric progression. Predictive performance was evaluated using receiver operating characteristic and multivariate analysis comparing TV, Koos class, and PCI. Results: Mean follow-up was 6.4 ± 4.0 years. The overall recurrence rate was 10%, varying by Koos class (I: 4%; II: 10%; III: 13%; IV: 10%; Conclusions: Pre-treatment TV is associated with radiosurgical outcome in VS. Increasing tumor size correlates with higher recurrence risk and reduced reliability of conformity indices-constituting a volume-conformity paradoxon with implications for individualized treatment planning, particularly for large tumors.
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