Useful hearing preservation is improved in vestibular schwannoma patients who undergo stereotactic radiosurgery before further hearing deterioration ensues

Ogino, Akiyoshi; Long, Hao; Johnson, Stephen A.; Niranjan, Ajay; Flíckinger, John C.; Lunsford, L. Dade; Kano, Hideyuki

doi:10.1007/s11060-021-03726-6

Cited by 7 publications

(6 citation statements)

References 26 publications

(24 reference statements)

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“…Sporadic and NF2-associated VSs seem to share this observation. 25 We attribute these results to the natural history of the vestibulocochlear nerve and its observed deterioration with old age. The hearing decline represents the main symptom of VS presentation among patients with NF2, with high rates of serviceable hearing loss.…”

Section: Discussionmentioning

confidence: 80%

“…8,10,23,24 Our NF2 outcome data confirmed lower serviceable hearing preservation rates than the results obtained in patients with sporadic VSs. [25][26][27][28] However, the reason for hearing deterioration in VSs, especially among patients with NF2, is likely multifactorial and remains largely unclear.…”

Section: Tumor Control and Serviceable Hearing Preservationmentioning

confidence: 99%

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Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

et al. 2023

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BACKGROUND:Vestibular schwannomas (VSs) related to neurofibromatosis type 2 (NF2) are challenging tumors. The increasing use of stereotactic radiosurgery (SRS) necessitates further investigations of its role and safety.OBJECTIVE:To evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiation-related risks of patients with NF2 after SRS for VS.METHODS:We performed a retrospective study of 267 patients with NF2 (328 VSs) who underwent single-session SRS at 12 centers participating in the International Radiosurgery Research Foundation. The median patient age was 31 years (IQR, 21-45 years), and 52% were male.RESULTS:A total of 328 tumors underwent SRS during a median follow-up time of 59 months (IQR, 23-112 months). At 10 and 15 years, the tumor control rates were 77% (95% CI: 69%-84%) and 52% (95% CI: 40%-64%), respectively, and the FFAT rate were 85% (95% CI: 79%-90%) and 75% (95% CI: 65%-86%), respectively. At 5 and 10 years, the serviceable hearing preservation rates were 64% (95% CI: 55%-75%) and 35% (95% CI: 25%-54%), respectively. In the multivariate analysis, age (hazards ratio: 1.03 [95% CI: 1.01-1.05]; P = .02) and bilateral VSs (hazards ratio: 4.56 [95% CI: 1.05-19.78]; P = .04) were predictors for serviceable hearing loss. Neither radiation-induced tumors nor malignant transformation were encountered in this cohort.CONCLUSION:Although the absolute volumetric tumor progression rate was 48% at 15 years, the rate of FFAT related to VS was 75% at 15 years after SRS. None of the patients with NF2-related VS developed a new radiation-related neoplasm or malignant transformation after SRS.

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Section: Discussionmentioning

confidence: 80%

Section: Tumor Control and Serviceable Hearing Preservationmentioning

confidence: 99%

Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

et al. 2023

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“…17 Several studies have suggested that early intervention may improve serviceable hearing retention. 18,19 In a previous study reported from our institution, Akpinar et al 19 reported that early radiosurgery was associated with better hearing preservation rates. In this study, we had a median interval between VS diagnosis and SRS of 23 months (IQR, 1-51).…”

Section: Hearing Preservation and Time Of Treatmentmentioning

confidence: 89%

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

et al. 2023

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BACKGROUND AND OBJECTIVES: The management of octogenarians with vestibular schwannomas (VS) has received little attention. However, with the increase in octogenarian population, more effort is needed to clarify the value of stereotactic radiosurgery (SRS) in this population. The aim of this study was to evaluate the safety and efficacy of SRS in this patient age group. METHODS: A retrospective study of 62 patients aged 80 years or older who underwent single-session SRS for symptomatic VS during a 35-year interval was performed. The median patient age was 82 years, and 61.3% were male. SRS was performed as planned adjuvant management or for delayed progression after prior partial resection in 5 patients. RESULTS: SRS resulted in a 5-year tumor control rate of 95.6% with a 4.8% risk of adverse radiation effects (ARE). Tumor control was unrelated to patient age, tumor volume, Koos grade, sex, SRS margin dose, or prior surgical management. Four patients underwent additional management including 1 patient with symptomatic progression requiring surgical resection, 2 patients with symptomatic hydrocephalus requiring cerebrospinal fluid diversion, and 1 patient whose tumor-related cyst required delayed cyst aspiration. Three patients developed ARE, including 1 patient with permanent facial weakness (House-Brackmann grade II), 1 who developed trigeminal neuropathy, and 1 who had worsening gait disorder. Six patients had serviceable hearing preservation before SRS, and 2 maintained serviceable hearing preservation after 4 years. A total of 44 (71%) patients died at an interval ranging from 6 to 244 months after SRS. CONCLUSION: SRS resulted in tumor and symptom control in most octogenarian patients with VS.

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“…Because of the association between postradiation long-term serviceable hearing and better preintervention hearing, some centers advocate for early, upfront radiation (48)(49)(50) even in the absence of hearing loss or tumor growth. However, there are several considerations to address with this approach.…”

Section: Review Of Contemporary Literaturementioning

confidence: 99%

Hearing Preservation After Intervention in Vestibular Schwannoma

et al. 2022

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ObjectiveThis study aimed to assess the durability of audiological outcomes after radiation and surgery in the management of vestibular schwannoma.Study DesignRetrospective review.SettingTertiary academic center.PatientsAdults with sporadic vestibular schwannoma and serviceable hearing at the time of intervention.InterventionsGamma Knife, middle cranial fossa, or retrosigmoid approaches.Main Outcome MeasuresPure-tone audiometry and speech discrimination scores.ResultsPostintervention serviceable hearing (class A/B) was preserved in 70.4% (n = 130; mean follow-up, 3.31 yr; range, 0–15.25 yr). Of the 49 patients treated with radiation, 19 (39.6%) had serviceable hearing at last follow-up, compared with 38 (46.9% of 81) who underwent retrosigmoid (n = 36 [44.4%]) and middle cranial fossa (n = 45 [55.6%]) approaches (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.67–2.82; p = 0.47). A matched analysis by age, tumor volume, and preintervention hearing (n = 38) also found no difference in hearing preservation (HP) likelihood between surgery and radiation (OR, 2.33; 95% CI, 0.24–35.91; p = 0.59). After initial HP, 4 (9.5%) surgical versus 10 (37.0%) radiated patients subsequently lost residual serviceable (A/B) hearing (OR, 0.18; 95% CI, 0.06–0.69; p = 0.01) at a mean 3.74 ± 3.58 and 4.73 ± 3.83 years after surgery and radiation, respectively. Overall, 5- and 10-year HP rates (A/B) after initially successful HP surgery were 84.4 and 63.0%, respectively. However, survival estimates declined to 48.9% at 5 years and 32.7% at 10 years when patients with immediate postoperative serviceable hearing loss were also included, which were comparable to radiation-HP rates at 5 and 10 years of 28.0 and 14.2%, respectively (p = 0.75).ConclusionsAfter vestibular schwannoma intervention, overall HP was similar between radiated and surgical cohorts. However, when successful, surgical approaches offered more durable hearing outcomes at long-term follow-up.

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Useful hearing preservation is improved in vestibular schwannoma patients who undergo stereotactic radiosurgery before further hearing deterioration ensues

Cited by 7 publications

References 26 publications

Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

Vestibular Schwannoma Stereotactic Radiosurgery in Octogenarians: Case Series

Hearing Preservation After Intervention in Vestibular Schwannoma

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