124PD - Strategic planning and teamwork key to immediate minimal side effects and early good outcome of stereotactic radiosurgery and radiotherapy in patie...

Date 19 December 2015
Event ESMO Asia 2015 Congress
Session CNS tumours
Topics Central Nervous System Malignancies
Surgical Oncology
Radiation Oncology
Presenter Mohamed Amin Mohamed Ali
Citation Annals of Oncology (2015) 26 (suppl_9): 34-36. 10.1093/annonc/mdv520
Authors M.A. Mohamed Ali1, A.Z. Abdul Latif2, Y. Yusoff1, M.F. Jaffar1, H.K. Sudarshan Singh3, N. Abdullah1
  • 1Radiotherapy & Oncology, National Cancer Institute, Precint 7 - Putrajaya/MY
  • 2Faculty Of Medicine, Universiti Sultan Zainal Abidin, 20400 - Kuala Terengganu/MY
  • 3Radiology, National Cancer Institute, Precint 7 - Putrajaya/MY



To evaluate the feasibility and early side effects of patients with vestibular schwannoma (VS) treated with stereotactic radiosurgery (SRS) and radiotherapy (SRT) in National Cancer Institute, Putrajaya in 2014


This study is based on an analysis of 14 patients with VS treated with stereotactic radiosurgery or radiotherapy in a newly setup cancer center in 2014 using a LINAC-based radiotherapy machine. Patients selection was done by a team of clinical oncologists, neurosurgeons and radiologists during tumour board meetings. All patients underwent pure tone audiometry, MR imaging and CT simulation planning sessions where these images were fused and treatment planning were done. A customised immobilisation device was fabricated during the CT simulation planning session using a frameless stereotactic mask system. 57% (n = 8) had SRS (12 Gy in single fraction) and 43% had hypofractionated SRT (35Gy in 7 fractions) as primary treatment. During treatment verification, image guidance consisting of dual in-room kV x-ray, two infrared cameras and 6D robotic couch patients positioning were used. The patients were then seen in clinic at six weeks post treatment to assess early side effects following which 6 monthly clinical and radiological assessments were done using MR imaging.


Both treatment modalities were well tolerated. Median follow-up time was 9 months. 29% (n = 4) experienced worsening headache (Grade 1 n = 2, Grade 2 n = 2) during 1st follow-up. At 6 months follow up, symptoms of headache were well controlled after conservative management and MR imaging showed stable disease in all patients.


This study showed that, with respect to early toxicity, SRS and SRT for patients with vestibular schwannoma showed to be a feasible and safe technique of treatment modality. However meticulous preparation from well trained staff, good teamwork between departments, sophisticated radiotherapy treatment machines, good quality control and assurance plays a major role behind the setup of this treatment modality.

Clinical trial identification


All authors have declared no conflicts of interest.