Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-center Study

Authors

• Steven D. Chang, Department of Neurosurgery, Stanford University, Stanford, CA, USA.
• Alexander Muacevic, European Cyberknife Center, Munich, DE.
• Andrea L. Klein, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: andreaklein@gwu.edu.
• Jonathan H. Sherman, Department of Neurosurgery, West Virginia University, Morgantown, WV, USA.
• Pantaleo Romanelli, Cyberknife Center, Centro Diagnostico Italiano, Milan, IT.
• Peter L. Santa Maria, Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA.
• Christoph Fuerweger, European Cyberknife Center, Munich, DE.
• Isa Bossi Zanetti, Cyberknife Center, Centro Diagnostico Italiano, Milan, IT.
• Giancarlo Beltramo, Cyberknife Center, Centro Diagnostico Italiano, Milan, IT.
• Yona Vaisbush, Technion, Haifa, IL.
• Emma Tran, Stanford University School of Medicine, Stanford, CA, USA.
• Austin Feng, Stanford University School of Medicine, Stanford, CA, USA.
• Hao Teng, Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, CN.
• Antonio Meola, Department of Neurosurgery, Stanford University, Stanford, CA, USA.
• Iris Gibbs, Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
• Antony M. Tolisano, Department of Otolaryngology, Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
• Joe Walter Kutz, Department of Otolaryngology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
• Zabi Wardak, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
• Lucien A. Nedzi, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
• Robert Hong, Virginia Hospital Center, Arlington, VA, USA.
• Don MacRae, Virginia Hospital Center, Arlington, VA, USA.
• Preet Sohal, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Elina Kapoor, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Parisa Sabet-Rasekh, Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Sam Maghami, Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Paola X. Moncada, Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Ashley Zaleski-King, Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Richard Amdur, Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Ashkan Monfared, Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Neurosurgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

5-31-2023

Journal

World neurosurgery

DOI

10.1016/j.wneu.2023.05.098

Keywords

Fractionation; hearing preservation; radiation dose; stereotactic radiosurgery; vestibular schwannoma

Abstract

BACKGROUND: 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. Effects of radiation parameters of SRS on hearing remain unknown. OBJECTIVES: The goal of this study is to determine the effect of tumor volume, patient demographics, pre-treatment 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 (PTA)s increased and word recognition scores (WRS)s 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. CONCLUSION: Decline of hearing at 1 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 hearing preservation at 1 year is 3 Gy, and the use of 3 fractions instead of 1 fraction was better at preserving hearing.

APA Citation

Chang, Steven D.; Muacevic, Alexander; Klein, Andrea L.; Sherman, Jonathan H.; Romanelli, Pantaleo; Santa Maria, Peter L.; Fuerweger, Christoph; Bossi Zanetti, Isa; Beltramo, Giancarlo; Vaisbush, Yona; Tran, Emma; Feng, Austin; Teng, Hao; Meola, Antonio; Gibbs, Iris; Tolisano, Antony M.; Kutz, Joe Walter; Wardak, Zabi; Nedzi, Lucien A.; Hong, Robert; MacRae, Don; Sohal, Preet; Kapoor, Elina; Sabet-Rasekh, Parisa; Maghami, Sam; Moncada, Paola X.; Zaleski-King, Ashley; Amdur, Richard; and Monfared, Ashkan, "Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-center Study" (2023). GW Authored Works. Paper 2842.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2842

Department

Surgery