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Increased cochlear radiation dose predicts delayed hearing loss following both stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannoma.
Patel, Kunal S; Ng, Edwin; Kaur, Taranjit; Miao, Tyler; Kaprealian, Tania; Lee, Percy; Pouratian, Nader; Selch, Michael T; De Salles, Antonio A F; Gopen, Quinton; Tenn, Stephen; Yang, Isaac.
Afiliación
  • Patel KS; Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA.
  • Ng E; Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA.
  • Kaur T; Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA.
  • Miao T; Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA.
  • Kaprealian T; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
  • Lee P; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
  • Pouratian N; Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA.
  • Selch MT; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
  • De Salles AAF; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
  • Gopen Q; Department of Neurosurgery, University of California Los Angeles, Los Angeles, USA.
  • Tenn S; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
  • Yang I; Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA.
J Neurooncol ; 145(2): 329-337, 2019 Nov.
Article en En | MEDLINE | ID: mdl-31552587
ABSTRACT

PURPOSE:

Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) are noninvasive therapies for vestibular schwannomas providing excellent tumor control. However, delayed hearing loss after radiation therapy remains an issue. One potential target to for improving hearing rates is limiting radiation exposure to the cochlea.

METHODS:

We retrospectively reviewed 100 patients undergoing either SRS with 12 Gy (n = 43) or fSRT with 50 Gy over 28 fractions (n = 57) for vestibular schwannoma. Univariate and multivariate analysis were carried out to identify predictors of hearing loss as measured by the Gardner Robertson scale after radiation therapy.

RESULTS:

Deterioration of hearing occurred in 30% of patients with SRS and 26% with fSRT. The overall long term (> 2 year) progression rates were 20% for SRS and 16% for fSRT. Patients with a decrease in their Gardner Robertson hearing score and those that loss serviceable hearing had significantly higher average minimal doses to the cochlea in both SRS and fSRT cohorts. ROC analysis showed that a cut off of 5 Gy and 35 Gy, for SRS and fSRT respectively, predicted hearing loss with high sensitivity/specificity.

CONCLUSION:

Our data suggests the minimal dose of radiation that the cochlear volume is exposed to is a predictor of delayed hearing loss after either SRS or fSRT. A threshold of 5 Gy/35 Gy may lead to improved hearing preservation after radiotherapy. Further prospective multi center studies can further elucidate this mechanism.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Neuroma Acústico / Radiocirugia / Fraccionamiento de la Dosis de Radiación / Pérdida Auditiva Sensorineural Tipo de estudio: Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Neurooncol Año: 2019 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Neuroma Acústico / Radiocirugia / Fraccionamiento de la Dosis de Radiación / Pérdida Auditiva Sensorineural Tipo de estudio: Prognostic_studies / Risk_factors_studies Idioma: En Revista: J Neurooncol Año: 2019 Tipo del documento: Article