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01-03-2017 | Original Article

Stereotactic radiotherapy of vestibular schwannoma

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

Authors: Florian Putz, MD, Jan Müller, Caterina Wimmer, MD, Nicole Goerig, Stefan Knippen, MD, Heinrich Iro, MD, Philipp Grundtner, Ilker Eyüpoglu, MD, Karl Rössler, MD, Sabine Semrau, MD, Rainer Fietkau, MD, Sebastian Lettmaier, MD

Published in: Strahlentherapie und Onkologie | Issue 3/2017

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.

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Jackler RK, Whinney D (2001) A century of eighth nerve surgery. Otol Neurotol 22(3):401–416CrossRefPubMed

Maier W, Hassepass F, Aschendorff A, Laszig R (2012) Vestibular schwannoma. Part 2: therapy, prognosis, and rehabilitation. HNO 60(10):927–935. doi:10.1007/s00106-012-2534-x (quiz 936–927)CrossRefPubMed

Samii M, Gerganov V, Samii A (2006) Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 105(4):527–535. doi:10.3171/jns.2006.105.4.527 CrossRefPubMed

Abboud T, Regelsberger J, Matschke J, Jowett N, Westphal M, Dalchow C (2015) Long-term vestibulocochlear functional outcome following retro-sigmoid approach to resection of vestibular schwannoma. Eur Arch Otorhinolaryngol 273(3):719–725. doi:10.1007/s00405-015-3561-5 CrossRefPubMed

Schmerber S, Palombi O, Boubagra K, Charachon R, Chirossel JP, Gay E (2005) Long-term control of vestibular schwannoma after a translabyrinthine complete removal. Neurosurgery 57(4):693–698 (discussion 693–698)CrossRefPubMed

Darrouzet V, Martel J, Enee V, Bebear JP, Guerin J (2004) Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope 114(4):681–688. doi:10.1097/00005537-200404000-00016 CrossRefPubMed

Kaylie DM, Horgan MJ, Delashaw JB, McMenomey SO (2000) A meta-analysis comparing outcomes of microsurgery and gamma knife radiosurgery. Laryngoscope 110(11):1850–1856. doi:10.1097/00005537-200011000-00016 CrossRefPubMed

Stangerup SE, Thomsen J, Tos M, Caye-Thomasen P (2010) Long-term hearing preservation in vestibular schwannoma. Otol Neurotol 31(2):271–275. doi:10.1097/MAO.0b013e3181c34bda CrossRefPubMed

Breivik CN, Nilsen RM, Myrseth E, Pedersen PH, Varughese JK, Chaudhry AA, Lund-Johansen M (2013) Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life. Neurosurgery 73(1):48–56. doi:10.1227/01.neu.0000429862.50018.b9 (discussion 56–47)CrossRefPubMed

10.

Fayad JN, Semaan MT, Lin J, Berliner KI, Brackmann DE (2014) Conservative management of vestibular schwannoma: expectations based on the length of the observation period. Otol Neurotol 35(7):1258–1265. doi:10.1097/mao.0000000000000285 PubMed

11.

Maier W, Grauvogel TD, Laszig R, Ridder GJ (2011) Value of different strategies in the treatment of vestibular schwannoma: therapeutic aspects and literature analysis. HNO 59(5):425–436. doi:10.1007/s00106-011-2302-3 CrossRefPubMed

12.

Kondziolka D, Mousavi SH, Kano H, Flickinger JC, Lunsford LD (2012) The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation? Neurosurg Focus 33(3):E8. doi:10.3171/2012.6.focus12192 CrossRefPubMed

13.

Liu W, Ni M, Jia W, Zhou D, Zhang Q, Jiang Y, Jia G (2015) How to address small- and medium-sized acoustic neuromas with hearing: a systematic review and decision analysis. World Neurosurg 84(2):283–291.e281. doi:10.1016/j.wneu.2015.03.013 CrossRefPubMed

14.

Pollock BE, Driscoll CL, Foote RL, Link MJ, Gorman DA, Bauch CD, Mandrekar JN, Krecke KN, Johnson CH (2006) Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 59(1):77–85. doi:10.1227/01.neu.0000219217.14930.14 (discussion 77–85)CrossRefPubMed

15.

Myrseth E, Moller P, Pedersen PH, Vassbotn FS, Wentzel-Larsen T, Lund-Johansen M (2005) Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery 56(5):927–935 (discussion 927–935)PubMed

16.

Myrseth E, Moller P, Pedersen PH, Lund-Johansen M (2009) Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 64(4):654–661. doi:10.1227/01.neu.0000340684.60443.55 (discussion 661–653)CrossRefPubMed

17.

Regis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, Zanaret M, Peragut JC (2002) Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97(5):1091–1100. doi:10.3171/jns.2002.97.5.1091 CrossRefPubMed

18.

Maniakas A, Saliba I (2012) Microsurgery versus stereotactic radiation for small vestibular schwannomas: a meta-analysis of patients with more than 5 years’ follow-up. Otol Neurotol 33(9):1611–1620. doi:10.1097/MAO.0b013e31826dbd02 CrossRefPubMed

19.

Sarmiento JM, Patel S, Mukherjee D, Patil CG (2013) Improving outcomes in patients with vestibular schwannomas: microsurgery versus radiosurgery. J Neurosurg Sci 57(1):23–44PubMed

20.

Chopra R, Kondziolka D, Niranjan A, Lunsford LD, Flickinger JC (2007) Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 68(3):845–851. doi:10.1016/j.ijrobp.2007.01.001 CrossRefPubMed

21.

Hasegawa T, Fujitani S, Katsumata S, Kida Y, Yoshimoto M, Koike J (2005) Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years. Neurosurgery 57(2):257–265 (discussion 257–265)CrossRefPubMed

22.

Yang I, Aranda D, Han SJ, Chennupati S, Sughrue ME, Cheung SW, Pitts LH, Parsa AT (2009) Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: a systematic review. J Clin Neurosci 16(6):742–747. doi:10.1016/j.jocn.2008.09.023 CrossRefPubMed

23.

Combs SE, Volk S, Schulz-Ertner D, Huber PE, Thilmann C, Debus J (2005) Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): long-term results in 106 patients treated in a single institution. Int J Radiat Oncol Biol Phys 63(1):75–81. doi:10.1016/j.ijrobp.2005.01.055 CrossRefPubMed

24.

Chan AW, Black P, Ojemann RG, Barker FG 2nd, Kooy HM, Lopes VV, McKenna MJ, Shrieve DC, Martuza RL, Loeffler JS (2005) Stereotactic radiotherapy for vestibular schwannomas: favorable outcome with minimal toxicity. Neurosurgery 57(1):60–70 (discussion 60–70)CrossRefPubMed

25.

Maire JP, Huchet A, Milbeo Y, Darrouzet V, Causse N, Celerier D, Liguoro D, Bebear JP (2006) Twenty years’ experience in the treatment of acoustic neuromas with fractionated radiotherapy: a review of 45 cases. Int J Radiat Oncol Biol Phys 66(1):170–178. doi:10.1016/j.ijrobp.2006.04.017 CrossRefPubMed

26.

Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88(3):506–512. doi:10.3171/jns.1998.88.3.0506 CrossRefPubMed

27.

Bhandare N, Jackson A, Eisbruch A, Pan CC, Flickinger JC, Antonelli P, Mendenhall WM (2010) Radiation therapy and hearing loss. Int J Radiat Oncol Biol Phys 76(3 Suppl):S50–S57. doi:10.1016/j.ijrobp.2009.04.096 CrossRefPubMedPubMedCentral

28.

Dorr W, Herrmann T, Baumann M (2014) Application of organ tolerance dose-constraints in clinical studies in radiation oncology. Strahlenther Onkol 190(7):621–624. doi:10.1007/s00066-014-0613-5 (626–627)CrossRefPubMed

29.

Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL (2015) Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas – pooled results from 3 large German centers. Radiother Oncol 114(3):378–383. doi:10.1016/j.radonc.2015.01.011 CrossRefPubMed

30.

Kopp C, Fauser C, Muller A, Astner ST, Jacob V, Lumenta C, Meyer B, Tonn JC, Molls M, Grosu AL (2011) Stereotactic fractionated radiotherapy and LINAC radiosurgery in the treatment of vestibular schwannoma-report about both stereotactic methods from a single institution. Int J Radiat Oncol Biol Phys 80(5):1485–1491. doi:10.1016/j.ijrobp.2010.04.057 CrossRefPubMed

31.

Anderson BM, Khuntia D, Bentzen SM, Geye HM, Hayes LL, Kuo JS, Baskaya MK, Badie B, Basavatia A, Pyle GM, Tome WA, Mehta MP (2014) Single institution experience treating 104 vestibular schwannomas with fractionated stereotactic radiation therapy or stereotactic radiosurgery. J Neurooncol 116(1):187–193. doi:10.1007/s11060-013-1282-4 CrossRefPubMed

32.

Badakhshi H, Muellner S, Wiener E, Budach V (2014) Image-guided stereotactic radiotherapy for patients with vestibular schwannoma. A clinical study. Strahlenther Onkol 190(6):533–537. doi:10.1007/s00066-014-0646-9 CrossRefPubMed

33.

Benghiat H, Heyes G, Nightingale P, Hartley A, Tiffany M, Spooner D, Geh JI, Cruickshank G, Irving RM, Sanghera P (2014) Linear accelerator stereotactic radiosurgery for vestibular schwannomas: a UK series. Clin Oncol 26(6):309–315. doi:10.1016/j.clon.2014.02.008 CrossRef

34.

Kranzinger M, Zehentmayr F, Fastner G, Oberascher G, Merz F, Nairz O, Rahim H, Sedlmayer F (2014) Hypofractionated stereotactic radiotherapy of acoustic neuroma: volume changes and hearing results after 89-month median follow-up. Strahlenther Onkol 190(9):798–805. doi:10.1007/s00066-014-0630-4 CrossRefPubMed

35.

Boari N, Bailo M, Gagliardi F, Franzin A, Gemma M, del Vecchio A, Bolognesi A, Picozzi P, Mortini P (2014) Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. J Neurosurg 121(Suppl):123–142. doi:10.3171/2014.8.gks141506 PubMed

36.

Champ CE, Shen X, Shi W, Mayekar SU, Chapman K, Werner-Wasik M, Farrell CJ, Gunn V, Downes MB, Liu H, Evans JJ, Andrews DW (2013) Reduced-dose fractionated stereotactic radiotherapy for acoustic neuromas: maintenance of tumor control with improved hearing preservation. Neurosurgery 73(3):489–496. doi:10.1227/neu.0000000000000019 CrossRefPubMed

37.

Combs SE, Welzel T, Schulz-Ertner D, Huber PE, Debus J (2010) Differences in clinical results after LINAC-based single-dose radiosurgery versus fractionated stereotactic radiotherapy for patients with vestibular schwannomas. Int J Radiat Oncol Biol Phys 76(1):193–200. doi:10.1016/j.ijrobp.2009.01.064 CrossRefPubMed

38.

Koh ES, Millar BA, Menard C, Michaels H, Heydarian M, Ladak S, McKinnon S, Rutka JA, Guha A, Pond GR, Laperriere NJ (2007) Fractionated stereotactic radiotherapy for acoustic neuroma: single-institution experience at The Princess Margaret Hospital. Cancer 109(6):1203–1210. doi:10.1002/cncr.22499 CrossRefPubMed

39.

Litre F, Rousseaux P, Jovenin N, Bazin A, Peruzzi P, Wdowczyk D, Colin P (2013) Fractionated stereotactic radiotherapy for acoustic neuromas: a prospective monocenter study of about 158 cases. Radiother Oncol 106(2):169–174. doi:10.1016/j.radonc.2012.10.013 CrossRefPubMed

40.

Sawamura Y, Shirato H, Sakamoto T, Aoyama H, Suzuki K, Onimaru R, Isu T, Fukuda S, Miyasaka K (2003) Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 99(4):685–692. doi:10.3171/jns.2003.99.4.0685 CrossRefPubMed

41.

Horan G, Whitfield GA, Burton KE, Burnet NG, Jefferies SJ (2007) Fractionated conformal radiotherapy in vestibular schwannoma: early results from a single centre. Clin Oncol 19(7):517–522. doi:10.1016/j.clon.2007.02.017 CrossRef

42.

Woolf DK, Williams M, Goh CL, Henderson DR, Menashy RV, Simpson N, Mastroianni B, Collis CH (2013) Fractionated stereotactic radiotherapy for acoustic neuromas: long-term outcomes. Clin Oncol 25(12):734–738. doi:10.1016/j.clon.2013.08.002 CrossRef

43.

Thomas C, Di Maio S, Ma R, Vollans E, Chu C, Clark B, Lee R, McKenzie M, Martin M, Toyota B (2007) Hearing preservation following fractionated stereotactic radiotherapy for vestibular schwannomas: prognostic implications of cochlear dose. J Neurosurg 107(5):917–926. doi:10.3171/jns-07/11/0917 CrossRefPubMed

44.

Chung HT, Ma R, Toyota B, Clark B, Robar J, McKenzie M (2004) Audiologic and treatment outcomes after linear accelerator-based stereotactic irradiation for acoustic neuroma. Int J Radiat Oncol Biol Phys 59(4):1116–1121. doi:10.1016/j.ijrobp.2003.12.032 CrossRefPubMed

45.

Quist TS, Givens DJ, Gurgel RK, Chamoun R, Shelton C (2015) Hearing preservation after middle fossa vestibular schwannoma removal: Are the results durable? Otolaryngol Head Neck Surg 152(4):706–711. doi:10.1177/0194599814567874 CrossRefPubMed

46.

Carlson ML, Jacob JT, Pollock BE, Neff BA, Tombers NM, Driscoll CL, Link MJ (2013) Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline. J Neurosurg 118(3):579–587. doi:10.3171/2012.9.jns12919 CrossRefPubMed

47.

Hasegawa T, Kida Y, Kato T, Iizuka H, Yamamoto T (2011) Factors associated with hearing preservation after gamma knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 115(6):1078–1086. doi:10.3171/2011.7.jns11749 CrossRefPubMed

48.

Wackym PA, Runge-Samuelson CL, Nash JJ, Poetker DM, Albano K, Bovi J, Michel MA, Friedland DR, Zhu YR, Hannley MT (2010) Gamma knife surgery of vestibular schwannomas: volumetric dosimetry correlations to hearing loss suggest stria vascularis devascularization as the mechanism of early hearing loss. Otol Neurotol 31(9):1480–1487. doi:10.1097/MAO.0b013e3181f7d7d4 PubMed

49.

Timmer FC, Hanssens PE, van Haren AE, Mulder JJ, Cremers CW, Beynon AJ, van Overbeeke JJ, Graamans K (2009) Gamma knife radiosurgery for vestibular schwannomas: results of hearing preservation in relation to the cochlear radiation dose. Laryngoscope 119(6):1076–1081. doi:10.1002/lary.20245 CrossRefPubMed

50.

Kano H, Kondziolka D, Khan A, Flickinger JC, Lunsford LD (2009) Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma. J Neurosurg 111(4):863–873. doi:10.3171/2008.12.jns08611 CrossRefPubMed

51.

Tamura M, Carron R, Yomo S, Arkha Y, Muraciolle X, Porcheron D, Thomassin JM, Roche PH, Regis J (2009) Hearing preservation after gamma knife radiosurgery for vestibular schwannomas presenting with high-level hearing. Neurosurgery 64(2):289–296. doi:10.1227/01.neu.0000338256.87936.7c (discussion 296)CrossRefPubMed

52.

Lasak JM, Klish D, Kryzer TC, Hearn C, Gorecki JP, Rine GP (2008) Gamma knife radiosurgery for vestibular schwannoma: early hearing outcomes and evaluation of the cochlear dose. Otol Neurotol 29(8):1179–1186. doi:10.1097/MAO.0b013e31818b6639 CrossRefPubMed

53.

Regis J, Tamura M, Delsanti C, Roche PH, Pellet W, Thomassin JM (2008) Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery. Prog Neurol Surg 21:142–151. doi:10.1159/000156901 CrossRefPubMed

54.

Massager N, Nissim O, Delbrouck C, Delpierre I, Devriendt D, Desmedt F, Wikler D, Brotchi J, Levivier M (2007) Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome. J Neurosurg 107(4):733–739. doi:10.3171/jns-07/10/0733 PubMed

55.

Bennion NR, Nowak RK, Lyden ER, Thompson RB, Li S, Lin C (2016) Fractionated stereotactic radiation therapy for vestibular schwannomas: dosimetric factors predictive of hearing outcomes. Pract Radiat Oncol 6(5):e155–e162. doi:10.1016/j.prro.2015.11.015 CrossRefPubMed

56.

Baschnagel AM, Chen PY, Bojrab D, Pieper D, Kartush J, Didyuk O, Naumann IC, Maitz A, Grills IS (2013) Hearing preservation in patients with vestibular schwannoma treated with gamma knife surgery. J Neurosurg 118(3):571–578. doi:10.3171/2012.10.jns12880 CrossRefPubMed

57.

Jacob JT, Carlson ML, Schiefer TK, Pollock BE, Driscoll CL, Link MJ (2014) Significance of cochlear dose in the radiosurgical treatment of vestibular schwannoma: controversies and unanswered questions. Neurosurgery 74(5):466–474. doi:10.1227/neu.0000000000000299 (discussion 474)CrossRefPubMed

58.

Kim YH, Kim DG, Han JH, Chung HT, Kim IK, Song SW, Park JH, Kim JW, Kim YH, Park CK, Kim CY, Paek SH, Jung HW (2013) Hearing outcomes after stereotactic radiosurgery for unilateral intracanalicular vestibular schwannomas: implication of transient volume expansion. Int J Radiat Oncol Biol Phys 85(1):61–67. doi:10.1016/j.ijrobp.2012.03.036 CrossRefPubMed

Title: Stereotactic radiotherapy of vestibular schwannoma
Hearing preservation, vestibular function, and local control following primary and salvage radiotherapy
Authors: Florian Putz, MD
Jan Müller
Caterina Wimmer, MD
Nicole Goerig
Stefan Knippen, MD
Heinrich Iro, MD
Philipp Grundtner
Ilker Eyüpoglu, MD
Karl Rössler, MD
Sabine Semrau, MD
Rainer Fietkau, MD
Sebastian Lettmaier, MD
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 3/2017
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-1086-5

At a glance: The STEP trials

Springer Medicine

Stereotactic radiotherapy of vestibular schwannoma

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

Abstract

Objective

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Patients and methods

Results

Conclusion

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