Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression.

OBJECTIVE: The safety of single-treatment stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) with radiographic evidence of brainstem compression but without motor deficit is controversial. Data on linear accelerator (linac)-based SRS in this setting are scarce. We address this with an outcomes report from an unselected series of patients with VS with radiographic brainstem compression treated with linac SRS. METHODS: We included 139 patients with unilateral VS (any size) with radiographic brainstem compression (all without serious brainstem neurological deficits). The SRS prescription dose was 12.5 Gy (single fraction) using 6MV linac-produced photon beams, delivered with a multiple arc technique. Inclusion criteria required at least 1 year of radiographic follow-up with magnetic resonance imaging. The primary endpoint was freedom from serious brainstem toxicity (≥grade 3 Common Terminology Criteria for Adverse Events v5); the secondary was freedom from enlargement (tumor progression or any requiring intervention). We assessed serious cranial nerve complications, excluding hearing loss, defined as Common Terminology Criteria for Adverse Events v5 grade 3 toxicity. RESULTS: Median magnetic resonance imaging follow-up time was 5 years, and median tumor size was 2.5 cm in greatest axial dimension and 5 ml in volume. The median brainstem D0.03 ml=12.6 Gy and median brainstem V10 Gy=0.4 ml. At 5 years, the actuarial freedom from serious brainstem toxicity was 100%, and freedom from tumor enlargement (requiring surgery and/or due to progression) was 90%. Severe facial nerve damage in patients without tumor enlargement was 0.9%. CONCLUSION: Linac-based SRS, as delivered in our series for VS with radiographic brainstem compression, is safe and effective.

Predictors of an Academic Career in Radiation Oncology 5 to 10 Years After Residency.

OBJECTIVE: To report the percentage of resident graduates in the modern era who establish careers in academic radiation oncology 5 to 10 years after residency. MATERIALS AND METHODS: The study population included 1147 radiation oncologists who completed residency between 2011 and 2017 and were practicing radiation oncologists in 2021. RESULTS: The percentage of 2011-2017 graduates with an academic career in 2021 (5 to 10 y after residency): Holman Pathway resident: Yes, 74% versus No, 43% ( P <0.05); PhD degree before residency: Yes, 67% versus No, 38% ( P <0.05), Doximity top-10 ranked residency program: Yes, 66% versus No, 37% ( P <0.05).Logistic regression multivariate analysis confirmed PhD and Doximity top-10 as strong independent predictors for all endpoints.Regarding gender, no significant differences were observed for all 4 endpoints in the percentage of women versus men establishing academic careers at the 5-year to 10-year post-residency time point. CONCLUSION: Since 2011, at least one-third (~35%) of radiation oncology residents have gone into academic medicine and are academically productive 5 to 10 years after residency. Holman Pathway, PhD degree, or Doximity top-10 residency program approximately doubles the probability of an academic career. Moreover, radiation oncology is on track to achieve gender equity in academic medicine.