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Comparison of Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy of Acoustic Neurinomas According to 3-D Tumor Volume Shrinkage and Quality of Life

Vergleich zwischen stereotaktischer Radiochirurgie und stereotaktisch-fraktionierter Radiotherapie von Akustikusneurinomen hinsichtlich 3-D-Tumorvolumenregression und Lebensqualität

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Background and Purpose:

Stereotactic radiosurgery (SRS) and also fractionated stereotactic radiotherapy (SRT) offer high local control (LC) rates (> 90%). This study aimed to evaluate three-dimensional (3-D) tumor volume (TV) shrinkage and to assess quality of life (QoL) after SRS/SRT.

Patients and Methods:

From 1999 to 2005, 35/74 patients were treated with SRS, and 39/74 with SRT. Median age was 60 years. Treatment was delivered by a linear accelerator. Median single dose was 13 Gy (SRS) or 54 Gy (SRT). Patients were followed up ≥ 12 months after SRS/SRT. LC and toxicity were evaluated by clinical examinations and magnetic resonance imaging. 3-D TV shrinkage was evaluated with the planning system. QoL was assessed using the questionnaire Short Form-36.

Results:

Median follow-up was 50/36 months (SRS/SRT). Actuarial 5-year freedom from progression/overall survival was 88.1%/100% (SRS), and 87.5%/87.2% (SRT). TV shrinkage was 15.1%/40.7% (SRS/SRT; p = 0.01). Single dose (< 13 Gy) was the only determinant factor for TV shrinkage after SRS (p = 0.001). Age, gender, initial TV, and previous operations did not affect TV shrinkage. Acute or late toxicity (≥ grade 3) was never seen. Concerning QoL, no significant differences were observed after SRS/SRT. Previous operations and gender did not affect QoL (p > 0.05). Compared with the German normal population, patients had worse values for all domains except for mental health.

Conclusion:

TV shrinkage was significantly higher after SRT than after SRS. Main symptoms were not affected by SRS/SRT. Retrospectively, QoL was neither affected by SRS nor by SRT.

Hintergrund und Ziel:

Die stereotaktische Radiochirurgie (SRS) und die stereotaktische Radiotherapie (SRT) erreichen Tumorkontrollraten von > 90%. Diese Studie hatte zum Ziel, die Tumorvolumenregression und die Lebensqualität (QoL) nach SRS/SRT zu evaluieren.

Patienten und Methodik:

Zwischen 1999 und 2005 wurden 35/74 Patienten mit einer SRS und 39/74 mit einer SRT behandelt. Das mediane Alter betrug 60 Jahre. Die Bestrahlungen erfolgten mit einem Linearbeschleuniger (6-MV-Photonen) mit einer medianen Einzeldosis von 13 Gy (SRS) oder mit einer Gesamtherddosis von 54 Gy (SRT). Lokale Kontrolle und Toxizität wurden mittels klinischer Untersuchungen und magnetresonanztomographischer Kontrollen, die Tumorvolumenregression am Planungssystem ≥ 12 Monate nach SRS/SRT evaluiert. Die QoL wurde 12 Monate nach SRS/SRT mit dem Fragebogen Short Form-36 evaluiert.

Ergebnisse:

Die mediane Nachbeobachtungszeit betrug 50/36 Monate (SRS/SRT). Das progressionsfreie 5-Jahres-Überleben und das 5-Jahres-Gesamtüberleben betrugen 88,1%/100% (SRS) und 87,5%/87,2% (SRT). Die Tumorvolumenregression lag bei 15,1%/40,7% (SRS/SRT; p = 0,01). Eine Einzeldosis (< 13 Gy) war der einzige determinierende Faktor der SRS (p = 0,001). Alter, Geschlecht und Voroperationen hatten keinen Einfluss auf die Tumorvolumenregression. Akut- oder Spättoxizität (≥ Grad 3) trat nicht auf. Hinsichtlich der QoL konnten keine signifikanten Unterschiede zwischen SRS/SRT ermittelt werden. Voroperationen oder Geschlecht hatten keinen Einfluss (p > 0,05). Im Vergleich zur deutschen Normalbevölkerung wiesen die Patienten schlechtere Werte für alle Domänen außer für „mental health“ auf.

Schlussfolgerung:

Die Tumorvolumenregression war nach SRT signifikant höher als nach SRS, wodurch die Hauptsymptome nicht beeinflusst wurden. Die QoL wurde weder durch SRS noch durch SRT beeinträchtigt.

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Authors and Affiliations

  1. Department of Radiation Oncology, Philipps University Marburg, Marburg, Germany

    Martin Henzel, Markus W. Gross & Rita Engenhart-Cabillic

  2. Department of Stereotactic Neurosurgery and Radiosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany

    Klaus Hamm, Gunnar Surber & Gabriele Kleinert

  3. Department of Theoretical Surgery, Philipps University Marburg, Marburg, Germany

    Helmut Sitter

  4. Department of Radio-Oncology, University Hospital of Basel, Basel, Switzerland

    Markus W. Gross

  5. Department of Radiation Oncology Philipps, University Marburg, Baldingerstrasse, 35033, Marburg, Germany

    Martin Henzel

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  1. Martin Henzel
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  2. Klaus Hamm
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  4. Markus W. Gross
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Correspondence to Martin Henzel.

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Henzel, M., Hamm, K., Sitter, H. et al. Comparison of Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy of Acoustic Neurinomas According to 3-D Tumor Volume Shrinkage and Quality of Life. Strahlenther Onkol 185, 567–573 (2009). https://doi.org/10.1007/s00066-009-1959-y

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