Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma: Hearing preservation and patients' self-reported outcome based on an established questionnaire

Strahlenther Onkol (2017) 193:192199

http://crossmark.crossref.org/dialog/?doi=10.1007/s00066-016-1070-0&domain=pdf

Web End = DOI 10.1007/s00066-016-1070-0

ORIGINAL ARTICLE

Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma

Hearing preservation and patients self-reported outcome based on an established questionnaire

Kerstin A. Kessel1,2 Hanna Fischer1,2 Marco M. E. Vogel1,2 Markus Oechsner1 Henning Bier3 Bernhard Meyer4 Stephanie E. Combs1,2

Received: 28 July 2016 / Accepted: 6 October 2016 / Published online: 1 November 2016 Springer-Verlag Berlin Heidelberg 2016

Abstract

Background Stereotactic radiotherapy (RT) has been established as a valid treatment alternative in patients with vestibular schwannoma (VS). There is ongoing controversy regarding the optimal fractionation. Hearing preservation may be the primary goal for patients with VS, followed by maintenance of quality of life (QoL).

Methods From 2002 to 2015, 184 patients with VS were treated with radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT). A survey on current symptoms and QoL was conducted between February and June 2016. Results Median follow-up after RT was 7.5 years (range 014.4 years). Mean overall survival (OS) after RT was31.1 years, with 94 and 87% survival at 5 and 10 years, respectively. Mean progression-free survival (PFS) was13.3 years, with 5- and 10-year PFS of 92%. Hearing could be preserved in RS patients for a median of36.3 months (range 2.313.7 years). Hearing worsened in 17 (30%) cases. Median hearing preservation for FSRT was 48.7 months (range 0.013.8 years); 29 (23%) showed hearing deterioration. The difference in hearing preserva-

[envelopeback] Dr. Kerstin A. Kessel [email protected]

1 Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Strae 22, 81675 Munich, Germany

2 Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum Mnchen, Ingolstdter Landstrae 1, Neuherberg, Germany

3 Department of Otorhinolaryngology, Technical University of Munich (TUM), Ismaninger Strae 22, Munich, Germany4 Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Strae 22, Munich, Germany

tion was not signicant between RS and FSRT (p = 0.3). A total of 123/162 patients participated in the patient survey (return rate 76%). The results correlate well with the information documented in the patient les for tinnitus and facial and trigeminal nerve toxicity. Signicant differences appeared regarding hearing impairment, gait uncertainty, and imbalance.

Conclusion These data conrm that RS and FSRT are comparable in terms of local control for VS. RS should be reserved for smaller...