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Stereotactic radiotherapy of vestibular schwannoma

Hearing preservation, vestibular function, and local control following primary and salvage radiotherapy

Stereotaktische Strahlentherapie von Akustikusneurinomen

Hörerhalt, Vestibularfunktion und lokale Kontrolle nach primärer und Salvage-Strahlentherapie

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Abstract

Objective

The aim of this publication is to present long-term data on functional outcomes and tumor control in a cohort of 107 patients treated with stereotactic radiotherapy (RT) for vestibular schwannoma.

Patients and methods

Included were 107 patients with vestibular schwannoma (primary or recurrent following resection) treated with stereotactic RT (either fractioned or single-dose radiosurgery) between October 2002 and December 2013. Local control and functional outcomes were determined. Analysis of hearing preservation was limited to a subgroup of patients with complete audiometric data collected before treatment and during follow-up. Vestibular function test (FVT) results could be analyzed in a subset of patients and were compared to patient-reported dizziness.

Results

After a mean follow-up of 46.3 months, actuarial local control for the whole cohort was 100% after 2, 97.6% after 5, and 94.1% after 10 years. In patients with primary RT, serviceable hearing was preserved in 72%. Predictors for preservation of serviceable hearing in multivariate analysis were time of follow-up (odds ratio, OR = 0.93 per month; p = 0.021) and pre-RT tumor size (Koos stage I–IIa vs. IIb–IV; OR = 0.15; p = 0.031). Worsening of FVT results was recorded in 17.6% (N = 3). Profound discrepancy of patient-reported dizziness and FVT results was observed after RT. In patients with primary RT, worsening of facial nerve function occurred in 1.7% (N = 1).

Conclusion

Stereotactic RT of vestibular schwannoma provides good functional outcomes and high control rates. Dependence of hearing preservation on time of follow-up and initial tumor stage has to be considered.

Zusammenfassung

Zielsetzung

Präsentation von Langzeitdaten zu funktionellen Ergebnissen und Tumorkontrolle nach stereotaktischer Radiotherapie (RT) in einer Kohorte von 107 Patienten mit Akustikusneurinom.

Patienten und Methoden

Zwischen Oktober 2002 und Dezember 2013 wurden 107 Patienten mit Akustikusneurinom (primär oder rezidiviert nach vorangegangener Resektion) mittels stereotaktischer RT behandelt (entweder fraktioniert oder als Einzeitradiochirurgie). Bestimmt wurden lokale Kontrolle und funktionelle Ergebnisse. Der Hörerhalt wurde nur bei Patienten mit vollständigen audiometrischen Befunden prä- und posttherapeutisch ermittelt. Objektive Vestibularisdiagnostik (Vestibularfunktionstest, VFT) war in einer Patientensubgruppe verfügbar und wurde der patientenberichteten Schwindelsymptomatik gegenübergestellt.

Ergebnisse

Nach einem mittleren Follow-up von 46,3 Monaten war die aktuarische lokale Kontrolle im Gesamtkollektiv 100 % nach 2, 97,6 % nach 5 bzw. 94,1 % nach 10 Jahren. Bei Patienten mit primärer RT betrug der Erhalt von brauchbarem Hörvermögen 72 %. Prädiktoren hierfür waren in der multivariaten Analyse die Zeit nach Abschluss der RT (Odds Ratio [OR] 0,93 pro Monat; p = 0,021) und die prätherapeutische Tumorgröße (Koos-Stadium I–IIa vs. IIb–IV; OR = 0,15; p = 0,031). Eine Verschlechterung der objektiven Vestibularfunktion wurde bei 17,6 % beobachtet (N = 3). Nach RT ergab sich eine ausgeprägte Diskrepanz zwischen objektiver Vestibularfunktion und subjektiver Schwindelsymptomatik. Bei Patienten mit primärer RT trat bei 1,7 % eine Verschlechterung der Fazialisfunktion auf (N = 1).

Schlussfolgerung

Die stereotaktische RT beim Akustikusneurinom erreicht eine hohe lokale Kontrolle und gute funktionelle Ergebnisse. Die Abhängigkeit des Hörerhalts von der Dauer des Follow-up und der initialen Tumorausdehnung muss berücksichtigt werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054, Erlangen, Germany

    Florian Putz MD, Jan Müller, Caterina Wimmer MD, Nicole Goerig, Stefan Knippen MD, Sabine Semrau MD, Rainer Fietkau MD & Sebastian Lettmaier MD

  2. Department of Otorhinolaryngology—Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Waldstraße 1, 91054, Erlangen, Germany

    Heinrich Iro MD & Philipp Grundtner

  3. Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Ilker Eyüpoglu MD & Karl Rössler MD

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F. Putz, J. Müller, C. Wimmer, N. Goerig, S. Knippen, H. Iro, P. Grundtner, I. Eyüpoglu, K. Rössler, S. Semrau, R. Fietkau, and S. Lettmaier declare that they have no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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J. Müller and F. Putz contributed equally to this work.

The present work was performed in (partial) fulfillment of the requirements for obtaining the degree “Dr. med.”

Electronic supplementary material The online version of this article doi: 10.1007/s00066-016-1086-5 contains supplementary material, which is available to authorized users.

Appendix

Appendix

Table 4 Patient-reported dizziness after radiotherapy (RT) in relation to objective vestibular function
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Fig. 5
figure 5

Box plot showing the distribution of minimum (a) and maximum (b) cochlear doses in patients without (left) and with preserved serviceable hearing (right). EQD2 equivalent dose in 2 Gy fractions

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Putz, F., Müller, J., Wimmer, C. et al. Stereotactic radiotherapy of vestibular schwannoma. Strahlenther Onkol 193, 200–212 (2017). https://doi.org/10.1007/s00066-016-1086-5

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  • DOI: https://doi.org/10.1007/s00066-016-1086-5

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