Multisession stereotactic radiosurgery for large XXXX .

@entity1 @entity5513 @entity5773 @entity5 @entity4254 @entity4786
UNASSIGNED: OBJECT Microsurgery is not the only option for larger @entity5513 ( @entity5513 ); recent reviews have confirmed the feasibility and efficacy of radiosurgery for larger @entity5513 . This study illustrates the outcomes of a series of large @entity5513 after multisession stereotactic radiosurgery (SRS). METHODS A series of 33 @entity5513 larger than 8 cm(3) (range 8-24 cm(3), mean 11 cm(3), median 9.4 cm(3)) were treated using the CyberKnife from 2003 to 2011 with the multisession SRS technique in 2-5 fractions (14-19.5 Gy). Five @entity1 had undergone surgical removal and 5 had ventriculoperitoneal shunts. Nine @entity1 were eligible for but refused surgery. Twelve @entity1 were older than 70 years and 5 were younger than 40 years. Two female @entity1 had @entity4786 . RESULTS The follow-up period ranged from 12 to 111 months (median 48 months); radiological growth control was achieved in 94% of cases: 19 @entity5 (58%) displayed no size variation or reduction in @entity5 diameter; 12 (36%), after a transient enlargement, presented with arrested growth or shrinkage. Seven @entity1 had a volume reduction of more than 50%. Two @entity1 (6%) needed debulking and 2 were treated with ventriculoperitoneal shunts. Actuarial progressionfree survival rates at 1 year and 5 years were 97% and 83%, respectively. Hearing was retained in 7 of the 8 @entity1 with serviceable baseline hearing. Adverse events were limited to 1 case each of vertigo, @entity5773 , and @entity4254 . CONCLUSIONS The good control rate obtained with multisession SRS deepens the controversy of the radiobiology of @entity5513 and may extend the indication of radiation therapy (fractionated or SRS) for large @entity5513 to include @entity1 without symptoms of mass effect. The limited number of cases and short follow-up period do not provide sufficient support for widespread application of multisession SRS in young @entity1 . Further studies with multisession SRS are warranted.
