{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:57:31Z","timestamp":1792036651658,"version":"4.4.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"\n Importance<\/jats:title>\n Current guidelines for treating small- to medium-sized vestibular schwannoma recommend either upfront radiosurgery or waiting to treat until tumor growth has been detected radiographically.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether upfront radiosurgery provides superior tumor volume reduction to a wait-and-scan approach for small- to medium-sized vestibular schwannoma.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Randomized clinical trial of 100 patients with a newly diagnosed (&amp;lt;6 months) unilateral vestibular schwannoma and a maximal tumor diameter of less than 2 cm in the cerebellopontine angle as measured on magnetic resonance imaging. Participants were enrolled at the Norwegian National Unit for Vestibular Schwannoma from October 28, 2014, through October 3, 2017; 4-year follow-up ended on October 20, 2021.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomized to receive either upfront radiosurgery (n\u2009=\u200950) or to undergo a wait-and-scan protocol, for which treatment was given only upon radiographically documented tumor growth (n\u2009=\u200950). Participants underwent 5 annual study visits consisting of clinical assessment, radiological examination, audiovestibular tests, and questionnaires.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was the ratio between tumor volume at the trial end at 4 years and baseline (V\n 4<\/jats:sub>\n :V\n 0<\/jats:sub>\n ). There were 26 prespecified secondary outcomes, including patient-reported symptoms, clinical examinations, audiovestibular tests, and quality-of-life outcomes. Safety outcomes were the risk of salvage microsurgery and radiation-associated complications.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 100 randomized patients, 98 completed the trial and were included in the primary analysis (mean age, 54 years; 42% female). In the upfront radiosurgery group, 1 participant (2%) received repeated radiosurgery upon tumor growth, 2 (4%) needed salvage microsurgery, and 45 (94%) had no additional treatment. In the wait-and-scan group, 21 patients (42%) received radiosurgery upon tumor growth, 1 (2%) underwent salvage microsurgery, and 28 (56%) remained untreated. For the primary outcome of the ratio of tumor volume at the trial end to baseline, the geometric mean V\n 4<\/jats:sub>\n :V\n 0<\/jats:sub>\n was 0.87 (95% CI, 0.66-1.15) in the upfront radiosurgery group and 1.51 (95% CI, 1.23-1.84) in the wait-and-scan group, showing a significantly greater tumor volume reduction in patients treated with upfront radiosurgery (wait-and-scan to upfront radiosurgery ratio, 1.73; 95% CI, 1.23-2.44;\n P<\/jats:italic>\n \u2009=\u2009.002). Of 26 secondary outcomes, 25 showed no significant difference. No radiation-associated complications were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion and relevance<\/jats:title>\n Among patients with newly diagnosed small- and medium-sized vestibular schwannoma, upfront radiosurgery demonstrated a significantly greater tumor volume reduction at 4 years than a wait-and-scan approach with treatment upon tumor growth. These findings may help inform treatment decisions for patients with vestibular schwannoma, and further investigation of long-term clinical outcomes is needed.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02249572<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.12222","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T11:01:26Z","timestamp":1690887686000},"page":"421","source":"Crossref","is-referenced-by-count":67,"title":["Upfront Radiosurgery vs a Wait-and-Scan Approach for Small- or Medium-Sized Vestibular Schwannoma"],"prefix":"10.1001","volume":"330","author":[{"given":"Dhanushan","family":"Dhayalan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway"},{"name":"Department of Clinical Medicine, University of Bergen, Bergen, Norway"},{"name":"The Norwegian National Unit for Vestibular Schwannoma, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein Vesterli","family":"Tveiten","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway"},{"name":"The Norwegian National Unit for Vestibular Schwannoma, Haukeland University Hospital, Bergen, Norway"},{"name":"The Norwegian National Unit for Stereotactic Radiosurgery, Haukeland University Hospital, Bergen. 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