American journal of otolaryngology · 2025
Early results with hypofractionated gamma knife radiotherapy for treatment of vestibular schwannoma.
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Azmeh Omar, Barber Samuel R, King Maurice, Arriaga Moisés A
Аннотация
OBJECTIVE: Vestibular schwannoma (VS) management with stereotactic radiation previously only included stereotactic radiosurgery with Gamma Knife (GKRS) or LINAC-based radiotherapy (LBR). Hypofractionated Gamma Knife radiotherapy (hfGKRS) is a novel protocol potentially producing less toxicity than the alternatives. This study examines early results in tumor control, complications and hearing preservation outcomes in a consecutive series of VS patients treated with hfGKRS.
STUDY DESIGN: A retrospective review was conducted for all patients with unilateral VS treated with primary hfGKRS at an academic center between 2017 and 2023.
SETTING: Tertiary referral center.
INTERVENTIONS: Therapeutic.
MAIN OUTCOME MEASURES: Pre- and post-treatment imaging, notes and audiograms were analyzed. Tumor volumes were tabulated. Audiometric data recorded were pure-tone average (PTA), word recognition score (WRS), and speech reception threshold (SRT). Collected data included tinnitus, imbalance, House-Brackmann score, and facial spasms. Outcomes obtained were compared to literature controls of GKRS and LBR.
RESULTS: Twenty-five hfGKRS cases were identified. Mean tumor volume was 1.79 cm3 (range 0.14-9.29cm3). Mean patient follow-up was 28 months (range 6-86 months). Pre-treatment versus post-treatment hearing results were: PTA 62.9 dB versus 68.6 dB, WRS 40 % versus 30.8 % and SRT 33.1 dB versus 34.1 dB. The tumor control was 96 % and hearing was preserved in 80 % of patients with pre-treatment serviceable hearing. hfGKRS complications included tinnitus (12.5 %), dizziness (12.5 %), facial pain (8 %), and facial spasms (4 %).
CONCLUSION: Short term results for VS treated with hfGKRS had high rates of tumor control, favorable hearing results and comparable complication rates to literature reports for GKRS and LBR. Further follow-up is needed to adequately evaluate long-term outcomes of hfGKRS in tumor control, toxicity and hearing results in order to compare this technique with GKRS and LBR. However, these results support further evaluation of hfGKRS as a potential technique to improve outcomes in stereotactic radiation treatment of VS.
STUDY DESIGN: A retrospective review was conducted for all patients with unilateral VS treated with primary hfGKRS at an academic center between 2017 and 2023.
SETTING: Tertiary referral center.
INTERVENTIONS: Therapeutic.
MAIN OUTCOME MEASURES: Pre- and post-treatment imaging, notes and audiograms were analyzed. Tumor volumes were tabulated. Audiometric data recorded were pure-tone average (PTA), word recognition score (WRS), and speech reception threshold (SRT). Collected data included tinnitus, imbalance, House-Brackmann score, and facial spasms. Outcomes obtained were compared to literature controls of GKRS and LBR.
RESULTS: Twenty-five hfGKRS cases were identified. Mean tumor volume was 1.79 cm3 (range 0.14-9.29cm3). Mean patient follow-up was 28 months (range 6-86 months). Pre-treatment versus post-treatment hearing results were: PTA 62.9 dB versus 68.6 dB, WRS 40 % versus 30.8 % and SRT 33.1 dB versus 34.1 dB. The tumor control was 96 % and hearing was preserved in 80 % of patients with pre-treatment serviceable hearing. hfGKRS complications included tinnitus (12.5 %), dizziness (12.5 %), facial pain (8 %), and facial spasms (4 %).
CONCLUSION: Short term results for VS treated with hfGKRS had high rates of tumor control, favorable hearing results and comparable complication rates to literature reports for GKRS and LBR. Further follow-up is needed to adequately evaluate long-term outcomes of hfGKRS in tumor control, toxicity and hearing results in order to compare this technique with GKRS and LBR. However, these results support further evaluation of hfGKRS as a potential technique to improve outcomes in stereotactic radiation treatment of VS.