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Journal of Neuro-Oncology

, Volume 145, Issue 2, pp 329–337 | Cite as

Increased cochlear radiation dose predicts delayed hearing loss following both stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannoma

  • Kunal S. Patel
  • Edwin Ng
  • Taranjit Kaur
  • Tyler Miao
  • Tania Kaprealian
  • Percy Lee
  • Nader Pouratian
  • Michael T. Selch
  • Antonio A. F. De Salles
  • Quinton Gopen
  • Stephen Tenn
  • Isaac YangEmail author
Clinical Study

Abstract

Purpose

Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) are noninvasive therapies for vestibular schwannomas providing excellent tumor control. However, delayed hearing loss after radiation therapy remains an issue. One potential target to for improving hearing rates is limiting radiation exposure to the cochlea.

Methods

We retrospectively reviewed 100 patients undergoing either SRS with 12 Gy (n = 43) or fSRT with 50 Gy over 28 fractions (n = 57) for vestibular schwannoma. Univariate and multivariate analysis were carried out to identify predictors of hearing loss as measured by the Gardner Robertson scale after radiation therapy.

Results

Deterioration of hearing occurred in 30% of patients with SRS and 26% with fSRT. The overall long term (> 2 year) progression rates were 20% for SRS and 16% for fSRT. Patients with a decrease in their Gardner Robertson hearing score and those that loss serviceable hearing had significantly higher average minimal doses to the cochlea in both SRS and fSRT cohorts. ROC analysis showed that a cut off of 5 Gy and 35 Gy, for SRS and fSRT respectively, predicted hearing loss with high sensitivity/specificity.

Conclusion

Our data suggests the minimal dose of radiation that the cochlear volume is exposed to is a predictor of delayed hearing loss after either SRS or fSRT. A threshold of 5 Gy/35 Gy may lead to improved hearing preservation after radiotherapy. Further prospective multi center studies can further elucidate this mechanism.

Keywords

Vestibular schwannoma Stereotactic radiosurgery Fractionated radiotherapy Serviceable hearing Cochlea 

Notes

Funding

Isaac Yang was partially supported by a Visionary Fund Grant, an Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research UCLA Scholars in Translational Medicine Program Award, the Jason Dessel Memorial Seed Grant, the UCLA Honberger Endowment Brain Tumor Research Seed Grant, and the STOP CANCER Research Career Development Award. The remaining authors have no disclosures or conflicts-of-interest.

Compliance with ethical standards

Conflict of interest

All authors that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kunal S. Patel
    • 1
  • Edwin Ng
    • 1
  • Taranjit Kaur
    • 2
  • Tyler Miao
    • 2
  • Tania Kaprealian
    • 3
  • Percy Lee
    • 3
  • Nader Pouratian
    • 1
    • 3
  • Michael T. Selch
    • 3
  • Antonio A. F. De Salles
    • 1
    • 3
  • Quinton Gopen
    • 2
  • Stephen Tenn
    • 3
  • Isaac Yang
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Department of NeurosurgeryUniversity of California Los AngelesLos AngelesUSA
  2. 2.Department of Head and Neck SurgeryUniversity of California Los AngelesLos AngelesUSA
  3. 3.Department of Radiation OncologyUniversity of California Los AngelesLos AngelesUSA
  4. 4.Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, UCLA Jonsson Comprehensive Cancer CenterLos AngelesUSA

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