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Erschienen in: Strahlentherapie und Onkologie 3/2017

01.11.2016 | Original Article

Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma

Hearing preservation and patients’ self-reported outcome based on an established questionnaire

verfasst von: Dr. Kerstin A. Kessel, Hanna Fischer, Marco M. E. Vogel, Markus Oechsner, Henning Bier, Bernhard Meyer, Stephanie E. Combs

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 3/2017

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Abstract

Background

Stereotactic radiotherapy (RT) has been established as a valid treatment alternative in patients with vestibular schwannoma (VS). There is ongoing controversy regarding the optimal fractionation. Hearing preservation may be the primary goal for patients with VS, followed by maintenance of quality of life (QoL).

Methods

From 2002 to 2015, 184 patients with VS were treated with radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT). A survey on current symptoms and QoL was conducted between February and June 2016.

Results

Median follow-up after RT was 7.5 years (range 0–14.4 years). Mean overall survival (OS) after RT was 31.1 years, with 94 and 87% survival at 5 and 10 years, respectively. Mean progression-free survival (PFS) was 13.3 years, with 5‑ and 10-year PFS of 92%. Hearing could be preserved in RS patients for a median of 36.3 months (range 2.3–13.7 years). Hearing worsened in 17 (30%) cases. Median hearing preservation for FSRT was 48.7 months (range 0.0–13.8 years); 29 (23%) showed hearing deterioration. The difference in hearing preservation was not significant between RS and FSRT (p = 0.3). A total of 123/162 patients participated in the patient survey (return rate 76%). The results correlate well with the information documented in the patient files for tinnitus and facial and trigeminal nerve toxicity. Significant differences appeared regarding hearing impairment, gait uncertainty, and imbalance.

Conclusion

These data confirm that RS and FSRT are comparable in terms of local control for VS. RS should be reserved for smaller lesions, while FSRT can be offered independently of tumor size. Patient self-reported outcome during follow-up is of high value. The established questionnaire could be validated in the independent cohort.
Literatur
2.
Zurück zum Zitat Golfinos JG, Hill TC, Rokosh R et al (2016) A matched cohort comparison of clinical outcomes following microsurgical resection or stereotactic radiosurgery for patients with small- and medium-sized vestibular schwannomas. J Neurosurg. doi:10.3171/2015.12.JNS151857 Golfinos JG, Hill TC, Rokosh R et al (2016) A matched cohort comparison of clinical outcomes following microsurgical resection or stereotactic radiosurgery for patients with small- and medium-sized vestibular schwannomas. J Neurosurg. doi:10.​3171/​2015.​12.​JNS151857
5.
Zurück zum Zitat Monfared A, Corrales E, Theodosopoulos P et al (2016) Facial nerve outcome and tumor control rate as a function of degree of resection in treatment of large acoustic neuromas: preliminary report of the acoustic neuroma subtotal resection study. Neurosurgery. doi:10.1227/NEU.0000000000001162 Monfared A, Corrales E, Theodosopoulos P et al (2016) Facial nerve outcome and tumor control rate as a function of degree of resection in treatment of large acoustic neuromas: preliminary report of the acoustic neuroma subtotal resection study. Neurosurgery. doi:10.​1227/​NEU.​0000000000001162​
7.
Zurück zum Zitat Kopp C, Fauser C, Müller A et al (2011) Stereotactic fractionated radiotherapy and LINAC radiosurgery in the treatment of vestibular schwannoma-report about both stereotactic methods from a single institution. Int J Radiat Oncol Biol Phys 80:1485–1491. doi:10.1016/j.ijrobp.2010.04.057 CrossRefPubMed Kopp C, Fauser C, Müller A et al (2011) Stereotactic fractionated radiotherapy and LINAC radiosurgery in the treatment of vestibular schwannoma-report about both stereotactic methods from a single institution. Int J Radiat Oncol Biol Phys 80:1485–1491. doi:10.​1016/​j.​ijrobp.​2010.​04.​057 CrossRefPubMed
9.
Zurück zum Zitat Combs SE, Welzel T, Kessel KA et al (2013) Hearing preservation after radiotherapy for vestibular schwannomas is comparable to hearing deterioration in healthy adults and is accompanied by local tumor control and a highly preserved quality of life (QOL) as patients’ self-reported outcome. Radiother Oncol 106:175–180. doi:10.1016/j.radonc.2012.12.004 CrossRefPubMed Combs SE, Welzel T, Kessel KA et al (2013) Hearing preservation after radiotherapy for vestibular schwannomas is comparable to hearing deterioration in healthy adults and is accompanied by local tumor control and a highly preserved quality of life (QOL) as patients’ self-reported outcome. Radiother Oncol 106:175–180. doi:10.​1016/​j.​radonc.​2012.​12.​004 CrossRefPubMed
12.
Zurück zum Zitat Mendelsohn D, Westerberg BD, Dong C, Akagami R (2016) Clinical and radiographic factors predicting hearing preservation rates in large vestibular schwannomas. J Neurol Surg B Skull Base 77:193–198. doi:10.1055/s-0035-1564054 CrossRefPubMed Mendelsohn D, Westerberg BD, Dong C, Akagami R (2016) Clinical and radiographic factors predicting hearing preservation rates in large vestibular schwannomas. J Neurol Surg B Skull Base 77:193–198. doi:10.​1055/​s-0035-1564054 CrossRefPubMed
13.
Zurück zum Zitat Roessler K, Krawagna M, Bischoff B et al (2016) Improved postoperative facial nerve and hearing function in retrosigmoid vestibular schwannoma surgery significantly associated with semisitting position. World Neurosurg 87:290–297. doi:10.1016/j.wneu.2015.11.089 CrossRefPubMed Roessler K, Krawagna M, Bischoff B et al (2016) Improved postoperative facial nerve and hearing function in retrosigmoid vestibular schwannoma surgery significantly associated with semisitting position. World Neurosurg 87:290–297. doi:10.​1016/​j.​wneu.​2015.​11.​089 CrossRefPubMed
14.
Zurück zum Zitat Combs SE, Engelhard C, Kopp C et al (2015) Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas – pooled results from 3 large German centers. Radiother Oncol 114:378–383. doi:10.1016/j.radonc.2015.01.011 CrossRefPubMed Combs SE, Engelhard C, Kopp C et al (2015) Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas – pooled results from 3 large German centers. Radiother Oncol 114:378–383. doi:10.​1016/​j.​radonc.​2015.​01.​011 CrossRefPubMed
15.
Zurück zum Zitat Hasegawa T, Kida Y, Kato T et al (2013) Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 118:557–565. doi:10.3171/2012.10.JNS12523 CrossRefPubMed Hasegawa T, Kida Y, Kato T et al (2013) Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery. J Neurosurg 118:557–565. doi:10.​3171/​2012.​10.​JNS12523 CrossRefPubMed
17.
Zurück zum Zitat Combs SE, Welzel T, Schulz-Ertner D et al (2010) Differences in clinical results after LINAC-based single-dose radiosurgery versus fractionated stereotactic radiotherapy for patients with vestibular schwannomas. Int J Radiat Oncol Biol Phys 76:193–200. doi:10.1016/j.ijrobp.2009.01.064 CrossRefPubMed Combs SE, Welzel T, Schulz-Ertner D et al (2010) Differences in clinical results after LINAC-based single-dose radiosurgery versus fractionated stereotactic radiotherapy for patients with vestibular schwannomas. Int J Radiat Oncol Biol Phys 76:193–200. doi:10.​1016/​j.​ijrobp.​2009.​01.​064 CrossRefPubMed
18.
Zurück zum Zitat Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD (2013) Results of acoustic neuroma radiosurgery: an analysis of 5 years’ experience using current methods. J Neurosurg 119(Suppl):1–6PubMed Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD (2013) Results of acoustic neuroma radiosurgery: an analysis of 5 years’ experience using current methods. J Neurosurg 119(Suppl):1–6PubMed
Metadaten
Titel
Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma
Hearing preservation and patients’ self-reported outcome based on an established questionnaire
verfasst von
Dr. Kerstin A. Kessel
Hanna Fischer
Marco M. E. Vogel
Markus Oechsner
Henning Bier
Bernhard Meyer
Stephanie E. Combs
Publikationsdatum
01.11.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 3/2017
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-016-1070-0

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