TY - JOUR
T1 - Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas
T2 - A Multi-Center Study
AU - Chang, Steven D.
AU - Muacevic, Alexander
AU - Klein, Andrea L.
AU - Sherman, Jonathan H.
AU - Romanelli, Pantaleo
AU - Santa Maria, Peter L.
AU - Fuerweger, Christoph
AU - Bossi Zanetti, Isa
AU - Beltramo, Giancarlo
AU - Vaisbush, Yona
AU - Tran, Emma
AU - Feng, Austin
AU - Teng, Hao
AU - Meola, Antonio
AU - Gibbs, Iris
AU - Tolisano, Antony M.
AU - Kutz, Joe Walter
AU - Wardak, Zabi
AU - Nedzi, Lucien A.
AU - Hong, Robert
AU - MacRae, Don
AU - Sohal, Preet
AU - Kapoor, Elina
AU - Sabet-Rasekh, Parisa
AU - Maghami, Sam
AU - Moncada, Paola X.
AU - Zaleski-King, Ashley
AU - Amdur, Richard
AU - Monfared, Ashkan
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/10
Y1 - 2023/10
N2 - Objective: Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration. Methods: Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990–2020 and had pre- and post-treatment audiograms. Results: Pure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12–60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS. Conclusions: Decline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.
AB - Objective: Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration. Methods: Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990–2020 and had pre- and post-treatment audiograms. Results: Pure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12–60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS. Conclusions: Decline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.
KW - Fractionation
KW - Hearing preservation
KW - Radiation dose
KW - Stereotactic radiosurgery
KW - Vestibular schwannoma
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U2 - 10.1016/j.wneu.2023.05.098
DO - 10.1016/j.wneu.2023.05.098
M3 - Article
C2 - 37268187
AN - SCOPUS:85171429139
SN - 1878-8750
VL - 178
SP - e24-e33
JO - World neurosurgery
JF - World neurosurgery
ER -