What fractionation would you use for a young patient with a schwannoma that has regrown within 2 years of resection?
Would you favor conventional fractionation over hypofractionation/SRS for a young patient with "cellular" schwannoma (Ki-67 up to 30% focally) that has regrown to a Koos grade 3 within 2 years after initial resection?
Based on Shinya et al., PMID 37283526, high Ki-67 predicts much worse local control in meningioma, but not sure if conventional fractionation mitigates this, or if this is applicable to schwannoma. Any radiobiological considerations? Given young age, would prolonged fractionation increase risk of second malignancy/malignant transformation?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · GammaWest Cancer Services
Answered on
This is a complex scenario given the 2-year time interval for progression in conjunction with a Ki-67 up to 30%. It is not clear within the question whether initial resection was gross total or subtotal and whether the diagnosis of cellular schwannoma and its focally very high Ki-67 index were reach...
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Mednet MemberInvited Expert
Radiation Oncology · Mayo Clinic Florida
Answered on
I don't think there is any benefit to conventional fractionation over SRS for this young patient. I would argue that with sharper dose fall-off, I'd favor SRS.
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