Hearing Outcomes After Stereotactic Radiosurgery for Unilateral Intracanalicular Vestibular Schwannomas: Implication of Transient Volume Expansion

Kim, Young Hoon; Kim, Dong-Gyu; Han, Jung Ho; Chung, Hyun-Tai; Kim, In Kyung; Song, Sang Woo; Park, Jeong Hoon; Kim, Jin Wook; Kim, Yong Hui; Park, Chul‐Kee; Kim, Chae-Yong; Paek, Sun Ha; Jung, Hee Won

doi:10.1016/j.ijrobp.2012.03.036

Cited by 52 publications

(59 citation statements)

References 16 publications

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“…The median PTA increased significantly in patients with functional hearing ( n = 10, 20%) but remained under the threshold value of 50 dB for loss of functional hearing [4] at the last follow-up. This is similar to preexisting iAN studies [9]. In our study the percentage of median PTA level increase was 60.4% before and after SRS.…”

Section: Discussionsupporting

confidence: 92%

Long-term follow-up after stereotactic radiosurgery of intracanalicular acoustic neurinoma

et al. 2017

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BackgroundThe management of solely intracanalicular acoustic neurinoma (iAN) includes observation, microsurgical resection and radiation therapy. Treatment goals are long-term tumor control, hearing preservation and concurrently low side-effects. Stereotactic radiosurgery (SRS) has evolved as an alternative first-line treatment for small AN. Here we report about the long-term follow-up of a unique cohort of patients with iAN after LINAC or Cyberknife® based SRS.MethodsIn this single center retrospective analysis, we included all patients with iAN who underwent single session LINAC or Cyberknife® based SRS between 1993 and 2015, and who had a minimum follow-up period of six weeks. Patient data were analyzed in terms of radiological and clinical tumor control (no further treatment necessary), subjective preservation of serviceable hearing, objective change in pure tone averages (PTA), and adverse events rated by the Common Terminology Criteria for Adverse Events (CTCAE; v4.03).ResultsForty-nine patients (f/m = 21/28, median age 54 ± 12, range 20–77 years) were identified. Mean tumor volumes were 0.24 ± 0.12 cm3 (range, 0.1–0.68 cm3), the mean marginal dose was 12.6 ± 0.6 Gy (range, 11.0–14.0 Gy) and the prescription isodose was 75 ± 7.4% (range, 47–86%). Mean follow-up time was 65 months (range, 4–239 months).Radiological tumor control was 100% during further follow-up. 17 (35%) out of 49 patients had lost serviceable hearing prior to SRS. Those with preserved serviceable hearing remained stable in 78% (n = 25/32) at the last follow-up (LFU). The median PTA (n = 16) increased from 25.6 dB prior to SRS to 43.8 dB at LFU.Mild adverse events were observed temporarily in two patients (4%): one with CTCAE grade 1 facial nerve disorder after 3 months, resolving three months later, and one with CTCAE grade 2 facial muscle weakness resolving after 12 months. Three patients described permanent mild symptoms CTCAE grade 1 without limiting daily life (facial weakness n = 1, vertigo n = 2).ConclusionSRS for iAN shows long-term reliable tumor control with a high rate of hearing preservation without considerable permanent side effects, and can be proposed as a safe and effective treatment alternative to microsurgical resection.

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Section: Discussionsupporting

confidence: 92%

Long-term follow-up after stereotactic radiosurgery of intracanalicular acoustic neurinoma

et al. 2017

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“…Several factors have been associated with worse hearing including dose, tumor size, and dose to the cochlea, all of which are associated with total dose. 8,16,33 These data, along with other studies and within the limits of study design, support using lower doses to preserve hearing. 8,9,13 Prior studies have variably demonstrated a link between hearing preservation and factors including dose, tumor volume expansion, and age.…”

Section: Hearing Preservationsupporting

confidence: 64%

“…8,9,13 Prior studies have variably demonstrated a link between hearing preservation and factors including dose, tumor volume expansion, and age. 8,[33][34][35][36][37] Univariate and multivariate analysis were performed for the patients in our study. However, no correlation for PFS or hearing preservation with respect to age or tumor volume was found.…”

Section: Hearing Preservationmentioning

confidence: 99%

Low-Dose Gamma Knife Radiosurgery for Vestibular Schwannomas: Tumor Control and Cranial Nerve Function Preservation After 11 Gy

Schumacher

Lall

et al. 2016

J Neurol Surg B

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Objectives This study aims to report tumor control rates and cranial nerve function after low dose (11.0 Gy) Gamma knife radiosurgery (GKRS) in patients with vestibular schwannomas. Methods A retrospective chart review was performed on 30 consecutive patients with vestibular schwannomas treated from March 2004 to August 2010 with GKRS at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. The marginal dose for all patients was 11.0 Gy prescribed to the 50% isodose line. Median follow-up time was 42 months. The median treatment volume was 0.53 cm 3 . Hearing data were obtained from audiometry reports before and after radiosurgery. Results The actuarial progression free survival (PFS) based on freedom from surgery was 100% at 5 years. PFS based on freedom from persistent growth was 91% at 5 years. One patient experienced tumor progression requiring resection at 87 months. Serviceable hearing, defined as Gardner-Robertson score of I-II, was preserved in 50% of patients. On univariate and multivariate analyses, only higher mean and maximum dose to the cochlea significantly decreased the proportion of patients with serviceable hearing. Conclusion Vestibular schwannomas can be treated with low doses (11.0 Gy) of GKRS with good tumor control and cranial nerve preservation.

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“…The initial review could discard 997 records as not relevant to the topic or as inadequate regarding cohort size or follow-up time, and after reference cross-check 98 records were reviewed according to a systematic review protocol. After the second review round a final 19 records were found to fulfill all inclusion criteria [2, 6, 10, 15, 17, 19, 22, 24, 28, 29, 33, 36, 39, 44, 48, 50, 52, 53, 56]. No randomized studies (S1) were identified on the subject.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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ObjectiveRepeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) <3 cm in need of intervention. In this systematic review we aimed to compare results from single-fraction stereotactic radiosurgery (SRS) to fractionated stereotactic radiotherapy (FSRT) for patients with VS.Data sources and eligibility criteriaWe systematically searched MEDLINE, Web of Science, Embase and Cochrane and screened relevant articles for references. Publications from 1995 through 2014 with a minimum of 50 adult (>18 years) patients with unilateral VS, followed for a median of >5 years, were eligible for inclusion. After screening titles and abstracts of the 1094 identified articles and systematically reviewing 98 of these articles, 19 were included.InterventionPatients with unilateral VS treated with radiosurgery were compared to patients treated with fractionated stereotactic radiotherapy.ResultsNo randomized controlled trial (RCT) was identified. None of the identified controlled studies comparing SRS with FSRT were eligible according to the inclusion criteria. Nineteen case series on SRS (n = 17) and FSRT (n = 2) were included in the systematic review. Loss of tumor control necessitating a new VS-targeted intervention was found in an average of 5.0% of the patients treated with SRS and in 4.8% treated with FSRT. Mean deterioration ratio for patients with serviceable hearing before treatment was 49% for SRS and 45% for FSRT, respectively. The risk for facial nerve deterioration was 3.6% for SRS and 11.2% for FSRT and for trigeminal nerve deterioration 6.0% for SRS and 8.4% for FSRT. Since these results were obtained from case series, a regular meta-analysis was not attempted.ConclusionSRS and FSRT are both noninvasive treatment alternatives for patients with VS with low rates of treatment failure in need of rescue therapy. In this selection of patients, the progression-free survival rates were on the order of 92–100% for both treatment options. There is a lack of high-quality studies comparing radiation therapy alternatives for patients with VS. Finally, 19 articles reported long-term tumor control after SRS, while only 2 articles reported long-term FSRT results, making effect estimates more uncertain for FSRT.Electronic supplementary materialThe online version of this article (doi:10.1007/s00701-017-3164-6) contains supplementary material, which is available to authorized users.

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Hearing Outcomes After Stereotactic Radiosurgery for Unilateral Intracanalicular Vestibular Schwannomas: Implication of Transient Volume Expansion

Cited by 52 publications

References 16 publications

Long-term follow-up after stereotactic radiosurgery of intracanalicular acoustic neurinoma

Long-term follow-up after stereotactic radiosurgery of intracanalicular acoustic neurinoma

Low-Dose Gamma Knife Radiosurgery for Vestibular Schwannomas: Tumor Control and Cranial Nerve Function Preservation After 11 Gy

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

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