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Hypofractionated stereotactic radiotherapy of acoustic neuroma

Volume changes and hearing results after 89-month median follow-up

Hypofraktionierte stereotaktische Bestrahlung des Akustikusneurinoms

Volumenänderungen und Hörergebnisse nach einer medianen Nachbeobachtungszeit von 89 Monaten

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Abstract

Purpose

The goal of this work was to evaluate toxicity and local control following hypofractionated stereotactic radiation treatment with special focus on changes in tumor volume and hearing capacity.

Patients and methods

In all, 29 patients with unilateral acoustic neuroma were treated between 2001 and 2007 within a prospective radiation protocol (7 × 4 Gy ICRU dose). Median tumor volume was 0.9 ml. Follow-up started at 6 months and was repeated annually with MRI volumetry and audiometry. Hearing preservation was defined as preservation of Class A/B hearing according to the guidelines of the American Academy of Otolaryngology (1995).

Results

No patient had any intervention after a median imaging follow-up of 89.5 months, one patient showed radiological progression. Transient increase of tumor volume developed in 17/29 patients, whereas 22/29 patients (75.9 %) presented with a volume reduction at last follow-up. A total of 21 patients were eligible for hearing evaluation. Mean pure tone average (PTA) deteriorated from 39.3 to 65.9 dB and mean speech discrimination score (SDS) dropped from 74.3 to 38.1 %. The 5-year actuarial Class A/B hearing preservation rate was 50.0 ± 14.4 %.

Conclusion

Radiation increases only minimally, if at all, the hearing deterioration which emerges by observation alone. Presbyacusis is not responsible for this deterioration. Transient tumor enlargement is common. Today radiation of small- and medium-sized acoustic neuroma can be performed with different highly conformal techniques as fractionated treatment or single low-dose radiosurgery with equal results regarding tumor control, hearing preservation, and side effects. Hypofractionation is more comfortable for the patient than conventional regimens and represents a serious alternative to frameless radiosurgery.

Zusammenfassung

Ziel

Ziel der Studie war die Evaluierung der Toxizität und der lokalen Tumorkontrolle einer hypofraktionierten stereotaktischen Bestrahlung mit besonderem Augenmerk auf Veränderungen von Tumorvolumen und Hörvermögen.

Patienten und Methoden

Insgesamt wurden zwischen 2001 und 2007 29 Patienten mit unilateralem Akustikusneurinom innerhalb eines prospektiven Bestrahlungsprotokolls behandelt (7 mal 4 Gy ICRU-Dosis). Das mediane Tumorvolumen betrug 0,9 ml. Die Nachsorge startete nach 6 Monaten und wurde jährlich wiederholt mit MRI-Volumetrie und Audiometrie. Der Hörerhalt wurde definiert als Erhalt eines Class-A/B-Hörvermögens nach den Richtlinien der American Academy of Otolaryngology (1995).

Ergebnisse

Kein Patient benötigte eine Intervention nach einer medianen Nachbeobachtungszeit von 89,5 Monaten, ein Patient entwickelte eine radiologische Progression. Eine vorübergehende Volumenzunahme zeigte sich bei 17/29 Patienten nach 6 Monaten, eine Volumenreduktion wiesen 22/29 Patienten (75,9 %) bei der jüngsten Nachsorgeuntersuchung auf. Insgesamt waren 21 Patienten bezüglich des Hörerhalts auswertbar. Der Mittelwert im Tonaudiogramm (PTA) verschlechterte sich von 39,3 dB auf 65,9 dB, das durchschnittliche Sprachverständnis (SDS) fiel von 74,3 % auf 38,1 %. Der aktuarische 5-Jahres-Class-A/B-Hörerhalt betrug 50,0 ± 14,4 %.

Schlussfolgerung

Der Grad der Hörminderung nach Bestrahlung ist, wenn überhaupt, nur minimal deutlicher als nach alleiniger Beobachtung. Presbyakusis ist nicht verantwortlich für diese zunehmende Hypakusis. Eine vorübergehende Volumenzunahme ist häufig. Heute ist eine Bestrahlung von kleinen bis mittelgroßen Akustikusneurinomen mit jeder hochkonformalen Technik als fraktionierte oder niedrigdosierte singuläre Behandlung mit gleichwertigem Ergebnis bezüglich Tumorkontrolle, Hörerhalt und Nebenwirkungen durchführbar. Die hypofraktionierte Bestrahlung ist für den Patienten komfortabler als konventionelle Schemata und eine ernsthafte Alternative zur nichtinvasiven Radiochirurgie.

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Authors and Affiliations

  1. University Clinic of Radiotherapy and Radio-Oncology, Salzburg County Hospital, Paracelsus Medical University Clinics (PMU), Müllner Hauptstraße 48, 5020, Salzburg, Austria

    Manfred Kranzinger MD, Franz Zehentmayr, Gerd Fastner & Felix Sedlmayer

  2. University Clinic of Ear, Nose and Throat Diseases, Salzburg County Hospital, Paracelsus Medical University Clinics (PMU), Salzburg, Austria

    Gerhard Oberascher

  3. Medical Radiation Protection Unit, Salzburg County Hospital, Paracelsus Medical University Clinics, Salzburg, Austria

    Florian Merz & Hassan Rahim

  4. radART—Institute for Research and Development on Advanced Radiation Technologies, Salzburg County Hospital, Paracelsus Medical University Clinics, Salzburg, Austria

    Franz Zehentmayr & Felix Sedlmayer

  5. Clinic Bad Trissl, Oberaudorf, Germany

    Olaf Nairz

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  1. Manfred Kranzinger MD
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Correspondence to Manfred Kranzinger MD.

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Kranzinger, M., Zehentmayr, F., Fastner, G. et al. Hypofractionated stereotactic radiotherapy of acoustic neuroma. Strahlenther Onkol 190, 798–805 (2014). https://doi.org/10.1007/s00066-014-0630-4

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