The treatment of a large XXXX with fractionated stereotactic radiotherapy.

@entity1 @entity5513 @entity1276 @entity5 @entity391 @entity392
The treatment of @entity5513 ( @entity5513 ) usually involves surgical excision or stereotactic radiosurgery. However, for large @entity5513 (mean diameter  >  3  cm), stereotactic radiosurgery is rarely used, leaving @entity1 with limited noninvasive treatment options. Recently, the use of fractionated stereotactic radiotherapy (FSRT) has been effective in treating small to medium-sized @entity5513 . We present a @entity1 with a large @entity5513 treated with FSRT. The @entity1 was a 43-year-old @entity1 presenting with imbalance, @entity392 , vertigo, and right-sided hearing decline associated with @entity391 and @entity1276 . Magnetic resonance (MR) imaging revealed a large, 3.8-cm, @entity5513 compressing the fourth ventricle. Following right frontal ventriculoperitoneal shunt placement, the @entity1 underwent FSRT for treatment of the @entity5 . Using the Radionics X-Knife 4.0 3D treatment planning system, a total of 54  Gy was delivered in 1.8-Gy daily fractions with the prescription isodose line of 90%. Treatments were delivered using a dedicated Varian 6/100 linear accelerator, and head immobilization was achieved with the Gill-Thomas-Cosman relocatable stereotactic frame. The @entity1 was subsequently evaluated with serial contrast-enhanced MR imaging. Following FSRT, local control (defined as the absence of @entity5 progression) was achieved, and treatment was well tolerated. There was no hearing-related, trigeminal, or facial-nerve morbidity following FSRT at 63-month follow-up. Treating a @entity1 with a large @entity5513 with FSRT resulted in @entity5 control, with no trigeminal nerve, facial nerve, or hearing-related morbidity. These results support FSRT as a potential noninvasive treatment modality for @entity5513 some would consider too large for single-fraction stereotactic radiosurgery (SRS).
