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Five-year outcomes following hypofractionated stereotactic radiotherapy delivered in five fractions for acoustic neuromas: the mean cochlear dose may impact hearing preservation

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Abstract

Background

The aim of this study was to assess the clinical outcomes of acoustic neuromas (ANs) treated with hypofractionated stereotactic radiotherapy (hypo-FSRT) prescribed at a uniform dose.

Methods

Forty-seven patients with a unilateral AN were treated consecutively with hypo-FSRT between February 2007 and March 2012. Nineteen patients maintained a serviceable hearing status at the beginning of hypo-FSRT. The prescribed dose was 25 Gy delivered in five fractions per week to the isocenter, and the planning target volume was covered by the 80% isodose line.

Results

The median follow-up and audiometric follow-up periods were 61 and 52 months, respectively. The estimated tumor control rate at 5 years was 90% (95% CI 76–96). The existence of the cystic component before hypo-FSRT had a significantly worse impact on tumor control (p = 0.02). The estimated hearing preservation rates at 1, 3 and 5 years were 68% (95% CI 42–84), 41% (95% CI 20–62) and 36% (95% CI 15–57), respectively. A borderline significant difference was identified in the mean biological effective dose with an α/β value of 3 Gy (BED3) to the ipsilateral cochlea between the preserved hearing and hearing loss groups (19 Gy vs. 28 Gy) (p = 0.08).

Conclusions

Hypo-FSRT delivered in five fractions for unilateral ANs may achieve excellent tumor control with no severe facial or trigeminal complications. The mean BED3 in the cochlea may impact the hearing preservation rate. Therefore, the cochlear dose should be as low as possible.

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Authors and Affiliations

  1. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Zhiping Chen, Keiichi Takehana, Takashi Mizowaki, Megumi Uto, Kengo Ogura, Katsuyuki Sakanaka, Yuki Miyabe, Nobutaka Mukumoto & Masahiro Hiraoka

  2. Department of Neurosurgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Yoshiki Arakawa, Yohei Mineharu & Susumu Miyamoto

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  1. Zhiping Chen
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  2. Keiichi Takehana
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Correspondence to Takashi Mizowaki.

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Chen, Z., Takehana, K., Mizowaki, T. et al. Five-year outcomes following hypofractionated stereotactic radiotherapy delivered in five fractions for acoustic neuromas: the mean cochlear dose may impact hearing preservation. Int J Clin Oncol 23, 608–614 (2018). https://doi.org/10.1007/s10147-018-1267-6

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