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

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.

Department

Surgery

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