Longitudinal tumor response dynamics after staged gamma knife radiosurgery combined with bevacizumab in sporadic vestibular schwannoma
- 1Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 2Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
Abstract
Background: Vestibular schwannomas (VSs) are benign tumors of the eighth cranial nerve. Although Gamma Knife radiosurgery (GKRS) achieves durable tumor control, delayed regression and pseudoprogression remain clinical challenges. Staged GKRS combined with bevacizumab may alter post-radiosurgical tumor response patterns.
Aim: To compare longitudinal tumor response, pseudoprogression, and clinical outcomes between staged GKRS combined with bevacizumab and single-session GKRS alone in sporadic VSs.
Methods: We retrospectively reviewed 72 patients with sporadic VSs: 49 treated with staged GKRS plus bevacizumab and 23 with single-session GKRS alone. Longitudinal tumor volume changes were analyzed using multivariable linear mixed-effects models, while early volumetric enlargement was evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
Results: Compared with GKRS alone, staged GKRS plus bevacizumab showed significantly different response trajectories (treatment-by-time interaction, P < 0.001), with earlier and sustained regression. Greater tumor reduction was observed from 3 to 36 months (all adjusted P < 0.05). Early volumetric enlargement (>10%) occurred in 14.3% versus 60.9% of patients (HR, 0.16; 95% CI, 0.06–0.40; P < 0.001). Pseudoprogression occurred in 4.1% versus 17.4% of patients, without statistical significance (P = 0.078). Cystic tumor composition was independently associated with greater regression. BEV-related adverse events were mild and manageable.
Conclusion: Staged GKRS combined with bevacizumab was associated with earlier, more sustained tumor regression and a lower risk of early post-treatment enlargement in sporadic VSs. Larger baseline tumor volume and cystic composition were associated with greater regression. Pseudoprogression was numerically less frequent, although the difference was not statistically significant.
Trial registration: ChiCTR2600131856 (Chinese Clinical Trial Registry).
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BibTeX
@article{peng2026longitudinal,
title = {{Longitudinal tumor response dynamics after staged gamma knife radiosurgery combined with bevacizumab in sporadic vestibular schwannoma}},
author = {Zeyu Peng and Shangbo Wang and Jiao-jiao Cao and Hongchi Zhang and Jin Yang and Liang-Yun Hu and Ran-ran Dai and Si-Jian Pan and Cheng-Jie Qiu},
journal = {Clinical and Translational Radiation Oncology},
year = {2026},
month = oct,
doi = {10.1016/j.ctro.2026.101318},
url = {https://doi.org/10.1016/j.ctro.2026.101318},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Longitudinal tumor response dynamics after staged gamma knife radiosurgery combined with bevacizumab in sporadic vestibular schwannoma
AU - Zeyu Peng
AU - Shangbo Wang
AU - Jiao-jiao Cao
AU - Hongchi Zhang
AU - Jin Yang
AU - Liang-Yun Hu
AU - Ran-ran Dai
AU - Si-Jian Pan
AU - Cheng-Jie Qiu
PY - 2026
DA - 2026/10/14
JO - Clinical and Translational Radiation Oncology
DO - 10.1016/j.ctro.2026.101318
UR - https://doi.org/10.1016/j.ctro.2026.101318
AB - Background: Vestibular schwannomas (VSs) are benign tumors of the eighth cranial nerve. Although Gamma Knife radiosurgery (GKRS) achieves durable tumor control, delayed regression and pseudoprogression remain clinical challenges. Staged GKRS combined with bevacizumab may alter post-radiosurgical tumor response patterns. Aim: To compare longitudinal tumor response, pseudoprogression, and clinical outcomes between staged GKRS combined with bevacizumab and single-session GKRS alone in sporadic VSs. Methods: We retrospectively reviewed 72 patients with sporadic VSs: 49 treated with staged GKRS plus bevacizumab and 23 with single-session GKRS alone. Longitudinal tumor volume changes were analyzed using multivariable linear mixed-effects models, while early volumetric enlargement was evaluated using Kaplan-Meier estimates and Cox proportional hazards models. Results: Compared with GKRS alone, staged GKRS plus bevacizumab showed significantly different response trajectories (treatment-by-time interaction, P < 0.001), with earlier and sustained regression. Greater tumor reduction was observed from 3 to 36 months (all adjusted P < 0.05). Early volumetric enlargement (>10%) occurred in 14.3% versus 60.9% of patients (HR, 0.16; 95% CI, 0.06–0.40; P < 0.001). Pseudoprogression occurred in 4.1% versus 17.4% of patients, without statistical significance (P = 0.078). Cystic tumor composition was independently associated with greater regression. BEV-related adverse events were mild and manageable. Conclusion: Staged GKRS combined with bevacizumab was associated with earlier, more sustained tumor regression and a lower risk of early post-treatment enlargement in sporadic VSs. Larger baseline tumor volume and cystic composition were associated with greater regression. Pseudoprogression was numerically less frequent, although the difference was not statistically significant. Trial registration: ChiCTR2600131856 (Chinese Clinical Trial Registry).
SN - 2405-6308
ER -