Single-Session Versus Hypofractionated Stereotactic Radiosurgery for Vestibular Schwannoma: A Systematic Review and Meta-Analysis of Double-Arm Studies Publisher



Hajikarimloo B ; Tos SM ; Mohammadzadeh I ; Ebrahimi A ; Najari D ; Hasanzade A ; Hashemi R ; Hezaveh EB ; Habibi MA
Source: SN Comprehensive Clinical Medicine Published:2025

Abstract

Background: Both single-session stereotactic radiosurgery (S-SRS) and hypofractionated stereotactic radiosurgery (HF-SRS) have demonstrated promising clinical and radiological outcomes, with low adverse events, in patients with vestibular schwannoma (VS). However, the optimal fractionation protocol remains a topic of controversy in the literature. We aimed to compare the outcomes of S-SRS and HF-SRS in patients with VS in double-arm studies. Methods: A thorough literature search was performed on April 15, 2025. Studies that reported on local control (LC), serviceable hearing rate (SHP), facial nerve (FN) preservation, trigeminal nerve (TN) preservation, salvage intervention, or adverse radiation effects (ARE) for both S-SRS and HF-SRS were included. Results: Seventeen studies involving 1114 patients were included, comprising 438 S-SRS (39.3%) and 676 HF-SRS (60.7%) patients. The meta-analysis showed no significant differences in LC rate (odds ratio [OR]: 1.04, 95% CI: 0.55–1.96, P = 0.91), SHP rate (OR: 0.96, 95% CI: 0.57–1.62, P = 0.87), FN preservation rates (OR: 1.01, 95% CI: 0.51–2.00, P = 0.98), and TN preservation rates (OR: 1.00, 95% CI: 0.51–1.93, P = 0.99) between the S-SRS and HF-SRS groups. Additionally, the meta-analysis found no differences between groups for ARE rates (OR: 0.83, 95% CI: 0.56–1.24, P = 0.36). Conclusion: We found no significant differences between S-SRS and HF-SRS in treating VS patients. The best fractionation approach should be personalized, considering tumor size, initial hearing ability, and anatomical features. © 2025 Elsevier B.V., All rights reserved.