The role of stereotactic radiosurgery (SRS) for large vestibular schwannomas (VS) remains controversial, particularly for patients with cystic VS, which can grow rapidly and are often managed by microsurgical resection. OBJECTIVE: This study aimed to evaluate the volumetric response of cystic VS compared with solid VS following SRS in patients with treatment-naïve Koos grade III-IV tumors.
✦ The floor
Discussion
Signed responses from readers of the wire.
For radiation oncologists and neurotologists managing large cystic vestibular schwannomas, this study adds early volumetric response data for SRS, but clinicians should await longer follow-up outcome studies before adjusting treatment decision-making.
Cystic vestibular schwannomas are known to behave unpredictably after radiosurgery; characterizing early volumetric response in large, previously untreated cases could help refine patient selection and monitoring protocols.
- 01Study evaluated early tumor volume changes after SRS in Koos Grade III–IV cystic vestibular schwannomas.
- 02All patients were treatment-naive (no prior surgery or radiation) at time of SRS.
- 03Published in Practical Radiation Oncology (2026), a peer-reviewed oncology journal.
- 04Cystic vestibular schwannomas are considered higher-risk for SRS due to unpredictable swelling responses.
- 05Findings could inform monitoring timelines and expectations for patients receiving SRS for large tumors.
Stereotactic radiosurgery produces measurable early volumetric tumor response in treatment-naive Koos Grade III–IV cystic vestibular schwannomas.
studypartially supported- PMID
- 42722232
- DOI
- 10.1016/j.prro.2026.08.010.
- Journal
- Practical Radiation Oncology
- Publication type
- research_article
- Evidence level
- 4
- Population
- Treatment-naive patients with Koos Grade III–IV cystic vestibular schwannomas
- Intervention
- Stereotactic radiosurgery (SRS)
Primary outcomes
Early volumetric tumor response after SRS; Tumor volume change over early follow-up period