Managing vestibular schwannomas with radiosurgery and radiotherapy: AGREE II appraisal of clinical practice guidelines

Deepak Lakshmipathy; Eric Winter; Christian Fritz; Jacob Harris; Michelle Gentile; Alvaro Moreira; Karthik Rajasekaran

doi:10.1111/1754-9485.13640

Managing vestibular schwannomas with radiosurgery and radiotherapy: AGREE II appraisal of clinical practice guidelines

J Med Imaging Radiat Oncol. 2024 Mar 13. doi: 10.1111/1754-9485.13640. Online ahead of print.

Authors

Deepak Lakshmipathy¹, Eric Winter², Christian Fritz¹, Jacob Harris³, Michelle Gentile⁴, Alvaro Moreira⁵, Karthik Rajasekaran^{1

6}

Affiliations

¹ Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
² Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Department of Paediatrics, University of Texas Health Science Centre at San Antonio, San Antonio, Texas, USA.
⁶ Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 38477433
DOI: 10.1111/1754-9485.13640

Abstract

Introduction: Vestibular schwannomas (VSs) are rare, benign intracranial tumours that have prompted clinical practice guideline (CPG) creation given their complex management. Our aim was to utilize the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument to assess if such CPGs on the management of VSs with radiosurgery and radiotherapy are of acceptable quality.

Methods: Relevant CPGs were identified following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols. Experienced reviewers then extracted general CPG properties and rated their quality via the AGREE II instrument. Intraclass correlation coefficients (ICCs) were quantified to assess interrater reliability.

Results: Nine CPGs on the management of VSs with radiosurgery and radiotherapy were identified. All CPGs were created in the past six years and developed recommendations based on literature review and expert consensus. One guideline was deemed as high quality with seven others being moderate and one being low in quality. The clarity of the presentation domain had the highest mean scaled domain score of 96.0%. The domains of stakeholder involvement and applicability had the lowest means of 49.2% and 47.2%, respectively. ICCs were either good or excellent across all domains.

Conclusion: Current CPGs on the management of VSs with radiosurgery and radiotherapy are of acceptable quality but would greatly benefit from improvements in applicability, stakeholder involvement, editorial independence and rigour of development. We recommend CPG authors reference the European Association of Neuro-Oncology (EANO) guideline as a developmental framework with the Congress of Neurological Surgeons/American Association of Neurological Surgeons (CNS/AANS) CPG being a valid alternative.

Keywords: acoustic neuroma; quality improvement; radiosurgery; radiotherapy; vestibular schwannoma.