Pre-Treatment Physical Therapy for Acoustic Neuroma

(VS PREHAB Trial)

Overseen By Medical College of Wisconsin Cancer Center Clinical Trials Office

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Medical College of Wisconsin

Disqualifiers: Prior VS treatment, Secondary vestibular diagnoses, Others

Compensation: Varies

Number of Visits: 1

Duration: Varies based on treatment type

36 Participants Needed

Trial Summary

What is the purpose of this trial?

The study is a pilot efficacy study. The investigators aim to estimate mean baseline and post-treatment balance scores among Vestibular Schwannomas (VS) patients undergoing pretreatment rehab (PREHAB) or no PREHAB when managed with either surgery or radiosurgery.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

What data supports the effectiveness of this treatment for acoustic neuroma?

Research shows that stereotactic radiosurgery and fractionated stereotactic radiotherapy are effective treatments for controlling vestibular schwannoma (acoustic neuroma) with high tumor control rates around 90% and low side effects. Additionally, CyberKnife radiotherapy has shown a 77% hearing preservation rate at 2 years, making it a practical and effective option for patients. ^{1 2 3 4 5}

Is pre-treatment physical therapy for acoustic neuroma safe?

Research shows that stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannoma (a type of acoustic neuroma) are generally safe, with low rates of side effects (1-7%). These treatments are effective in controlling tumor growth and are considered safe options for managing this condition. ^{1 3 6 7 8}

How does pre-treatment physical therapy for acoustic neuroma differ from other treatments?

Pre-treatment physical therapy for acoustic neuroma is unique because it involves preparing patients for either microsurgical resection or stereotactic radiosurgery, which are precise, non-invasive treatments that target the tumor with high accuracy. This approach can help improve outcomes by potentially reducing the side effects and enhancing recovery compared to traditional surgical methods. ^{1 2 5 9 10}

Research Team

Michael Harris, MD

Principal Investigator

Medical College of Wisconsin

Eligibility Criteria

Adults diagnosed with Vestibular Schwannoma (VS) of size ≤2.5 cm, confirmed by MRI, who will undergo surgery or radiosurgery. Participants must be in good health as determined by normal lab values and have an ECOG Performance Status <2. Pregnant women or those not using effective contraception are excluded.

Inclusion Criteria

I am 18 years old or older.

My doctor confirmed I have a Vestibular Schwannoma with an MRI.

Be willing to adhere to outlined study protocol criteria and complete self-reported questionnaires (translations may be made available if the patient's primary language is not English)

Exclusion Criteria

I have had treatment for my VS, including surgery or radiotherapy.

I am expected to receive radiation therapy that is not stereotactic.

Women of childbearing potential who are known to be pregnant or are unwilling to use an acceptable method of contraception from the time of informed consent until completion of study related treatment and additional 24 weeks following stereotactic radiosurgery administration

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-Treatment Rehabilitation

Participants undergo PREHAB exercises including balance, gaze stabilization, and habituation exercises prior to surgery or radiosurgery

3 weeks

1 visit per week (in-person)

Treatment

Participants receive either microsurgical resection or stereotactic radiosurgery for vestibular schwannomas

Varies based on treatment type

Follow-up

Participants are monitored for safety and effectiveness after treatment, with primary endpoint measured at 12 months post-treatment

12 months

Treatment Details

Interventions

• Microsurgical resection of VS
• PREHAB
• Stereotactic radiosurgery

Trial Overview The trial is testing the effectiveness of pre-treatment vestibular physical therapy (PREHAB) on balance for patients with VS undergoing microsurgical resection or stereotactic radiosurgery compared to no PREHAB.

Participant Groups

Group I: Intervention: PREHAB and Surgery Active Control 2 Interventions

PREHAB exercises will be determined during the physical therapy visit (1x/week) and completed daily with varying frequency for three weeks. Subjects will undergo microsurgical resection of VS.

Group II: Intervention: PREHAB and SRS Active Control 2 Interventions

PREHAB exercises will be determined during the physical therapy visit (1x/week) and completed daily with varying frequency for three weeks. Subjects will undergo stereotactic radiosurgery.

Group III: Control: Surgery (No PREHAB) Placebo Group 1 Intervention

Subjects will undergo microsurgical resection of VS.

Group IV: Control: SRS (No PREHAB) Placebo Group 1 Intervention

Subjects will undergo stereotactic radiosurgery.

Microsurgical resection of VS is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Microsurgical resection of Vestibular Schwannoma for:

• Symptomatic Vestibular Schwannoma
• Large Vestibular Schwannomas causing brainstem compression or hydrocephalus

Approved in United States as Microsurgical resection of Vestibular Schwannoma for:

• Symptomatic Vestibular Schwannoma
• Large Vestibular Schwannomas causing brainstem compression or hydrocephalus

Approved in Canada as Microsurgical resection of Vestibular Schwannoma for:

• Symptomatic Vestibular Schwannoma
• Large Vestibular Schwannomas causing brainstem compression or hydrocephalus

Who Is Running the Clinical Trial?

Medical College of Wisconsin

Lead Sponsor

Trials

645

Recruited

1,180,000+

Findings from Research

Radiosurgery (RS) and stereotactic radiotherapy (SRT) both achieve high tumor control rates of around 90% for managing vestibular schwannoma (VS), with low side effect rates between 1-7%, making RS a preferred treatment for small, progressing tumors.

The management of VS should be interdisciplinary, with treatment decisions based on patient symptoms and tumor growth, emphasizing the importance of an initial 'wait and scan' strategy for incidental findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Radiosurgery and fractionated stereotactic radiotherapy of vestibular schwannoma]. Hamm, K., Herold, HU., Surber, G., et al.[2020]

Stereotactic radiosurgery is an effective treatment for vestibular schwannoma, offering excellent tumor control rates while minimizing the risks associated with traditional surgery.

Using the Cyberknife system for staged stereotactic radiotherapy has resulted in a 77% hearing preservation rate at 2 years, making it a promising option for patients seeking to maintain their hearing while managing their tumor.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cyberknife radiotherapy for vestibular schwannoma. Sakamoto, GT., Blevins, N., Gibbs, IC.[2018]

Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) both show low rates of treatment failure for vestibular schwannoma, with progression-free survival rates between 92-100% for both methods, based on a systematic review of 19 case series.

SRS has a lower risk of facial nerve deterioration (3.6%) compared to FSRT (11.2%), suggesting that SRS may be a safer option for preserving nerve function in patients with vestibular schwannoma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. Persson, O., Bartek, J., Shalom, NB., et al.[2022]

In a study of 162 patients treated with stereotactic radiosurgery for acoustic neuromas, the tumor control rate was an impressive 98%, with 62% of tumors shrinking over time.

Radiosurgery successfully preserved normal facial function in 79% of patients and trigeminal function in 73%, demonstrating its efficacy in maintaining neurologic function long-term.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term outcomes after radiosurgery for acoustic neuromas. Kondziolka, D., Lunsford, LD., McLaughlin, MR., et al.[2022]

Stereotactic radiosurgery is becoming a preferred treatment option for patients with acoustic neuromas, as it offers a non-invasive alternative to open surgical resection.

The report reviews the evolution of radiosurgery techniques and discusses the indications and expected outcomes, suggesting that ongoing research will continue to enhance treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acoustic neuroma radiosurgery. Origins, contemporary use and future expectations. Kondziolka, D., Lunsford, LD., Flickinger, JC.[2018]

Stereotactic radiosurgery using Gamma Knife for treating vestibular schwannoma is effective and safe, with a 5-year progression-free survival rate of 87% and a 10-year rate of 81% based on a study of 333 patients over an average follow-up of 60 months.

The study identified that 39.3% of patients experienced pseudo-progression, which can complicate the assessment of treatment outcomes, highlighting the importance of understanding this phenomenon to avoid misinterpreting tumor recurrence and to guide follow-up care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Stereotactic radiosurgery for vestibular schwannoma: early and long-term radiation-induced changes and tumor growth control]. Ilyalov, SR., Banov, SM., Golanov, AV., et al.[2022]

In a study of 452 patients who underwent gamma knife radiosurgery for vestibular schwannomas, only 2.9% required delayed microsurgery, indicating that failed radiosurgery is rare.

The difficulty of subsequent microsurgery varied, with most surgeons finding it more challenging than typical procedures, and outcomes showed that while some patients retained good facial function, others experienced significant complications, highlighting the need for careful evaluation before surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vestibular schwannoma management. Part II. Failed radiosurgery and the role of delayed microsurgery. Pollock, BE., Lunsford, LD., Kondziolka, D., et al.[2004]

Single-fraction stereotactic radiosurgery (sfSRS) shows greater benefits than microsurgical resection (MR) for patients with unilateral vestibular schwannoma, particularly in reducing facial palsy and improving hearing function, based on a review of three non-randomized trials involving 339 patients.

There were no significant differences in mortality, vertigo, headaches, tinnitus, balance function, or quality of life between the two treatment methods, but the long-term effectiveness of sfSRS remains uncertain due to a lack of extended follow-up studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single-fraction stereotactic radiosurgery versus microsurgical resection for the treatment of vestibular schwannoma: a systematic review and meta-analysis. Jakubeit, T., Sturtz, S., Sow, D., et al.[2022]

In a study of 17 patients with vestibular schwannomas treated with either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT), no adverse reactions or complications were reported, indicating a high safety profile for these radiation treatments.

Within 3 months post-treatment, three tumors showed shrinkage and improvement in neurological functions, suggesting that radiation therapy can effectively reduce tumor size and alleviate symptoms, even in cases of large tumors causing brain stem compression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for management of vestibular schwannomas: initial experience with 17 cases. Polovnikov, ES., Anikeeva, OY., Filatov, PV., et al.[2018]

Stereotactic radiotherapy (SRT) is an effective precision treatment for vestibular schwannomas, which are benign tumors affecting the eighth cranial nerve.

The review discusses both conventional and hypofractionated SRT regimens, highlighting their clinical outcomes and the underlying radio-biologic principles that support their use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic radiotherapy for vestibular schwannoma. Sweeney, P., Yajnik, S., Hartsell, W., et al.[2018]

References

1. Germany pubmed.ncbi.nlm.nih.gov

[Radiosurgery and fractionated stereotactic radiotherapy of vestibular schwannoma]. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Cyberknife radiotherapy for vestibular schwannoma. [2018]

3. Austria pubmed.ncbi.nlm.nih.gov

Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Long-term outcomes after radiosurgery for acoustic neuromas. [2022]

5. France pubmed.ncbi.nlm.nih.gov

Acoustic neuroma radiosurgery. Origins, contemporary use and future expectations. [2018]

6. Russia (Federation) pubmed.ncbi.nlm.nih.gov

[Stereotactic radiosurgery for vestibular schwannoma: early and long-term radiation-induced changes and tumor growth control]. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Vestibular schwannoma management. Part II. Failed radiosurgery and the role of delayed microsurgery. [2004]

8. England pubmed.ncbi.nlm.nih.gov

Single-fraction stereotactic radiosurgery versus microsurgical resection for the treatment of vestibular schwannoma: a systematic review and meta-analysis. [2022]

9. Austria pubmed.ncbi.nlm.nih.gov

Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for management of vestibular schwannomas: initial experience with 17 cases. [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Stereotactic radiotherapy for vestibular schwannoma. [2018]