Randomized trial of upfront radiosurgery versus wait-and-scan for small- or medium-sized vestibular schwannoma

Current guidelines for treating small- or medium-sized vestibular schwannoma recommend either upfront radiosurgery or waiting until tumor growth has been detected radiographically. The randomized V-REX trial at the Norwegian National Institute for Vestibular Schwannoma (Bergen) compared these two approaches. The trial that included 100 patients found that the mean ratio between tumor volume at 4 years versus baseline was 0.87 in the upfront radiosurgery group versus 1.51 in the wait-and-scan group, a significant difference. The authors conclude that among patients with small or medium vestibular schwannoma, upfront radiosurgery was more effective at reducing tumor volume at 4 years than was the initial wait-and-scan approach (visual abstract).