Journal article
Reduced-Dose Fractionated Stereotactic Radiotherapy for Acoustic Neuromas: Maintenance of Tumor Control With Improved Hearing Preservation
Neurosurgery, v 73(3), pp 489-496
01 Sep 2013
PMID: 23756743
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Fractionated stereotactic radiotherapy (FSRT) is a noninvasive treatment for acoustic neuromas (ANs). Initial reports from our institution demonstrated that the reduction of treatment dose to 46.8 Gy resulted in improved preservation of functional hearing status.
OBJECTIVE: We now report the tumor control (TC), symptomatic outcome, and hearing preservation (HP) rate in patients treated with reduced-dose FSRT.
METHODS: We analyzed all patients with AN treated from 2002 to 2011. All patients received 46.8 Gy in 1.8-Gy fractions. Follow-up audiogram and magnetic resonance imaging were performed in <= 1-year intervals. TC and HP were calculated by the Kaplan-Meier method. Analysis of HP, defined as Gardner-Robertson value <= 2, was determined by audiometric data. Non-hearing-related symptoms were defined by Common Terminology Criteria for Adverse Events version 4.
RESULTS: In total, 154 patients were analyzed. At a median follow-up of 35 months (range, 4-108), TC was achieved in 96% of patients (n = 148/154) and at 3 and 5 years was 99% and 93%. Eighty-seven patients had serviceable hearing at the time of FSRT and evaluable audiometric follow-up. Overall HP was 67% and at 3 and 5 years was 66% and 54%. Pure tone average decreased by a median of 13 dB in all patients. Nineteen percent (n = 31) of patients experienced symptom improvement, and 8% (n = 13) had worsening of symptoms. Cranial nerve dysfunction occurred in 3.8% of patients (n = 6).
CONCLUSION: Reduced-dose FSRT to 46.8 Gy for AN achieves excellent functional HP rates and limited toxicity without compromising long-term TC. Based on these promising outcomes, further attempts at dose deescalation may be warranted.
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Details
- Title
- Reduced-Dose Fractionated Stereotactic Radiotherapy for Acoustic Neuromas: Maintenance of Tumor Control With Improved Hearing Preservation
- Creators
- Colin E. Champ - Thomas Jefferson UniversityXinglei Shen - University of Kansas Medical CenterWenyin Shi - Thomas Jefferson UniversitySonal U. Mayekar - Thomas Jefferson UniversityKatherine Chapman - Thomas Jefferson UniversityMaria Werner-Wasik - Thomas Jefferson UniversityChristopher J. Farrell - Sidney Kimmel Cancer CenterVicki Gunn - Thomas Jefferson UniversityM. Beverly Downes - Thomas Jefferson UniversityHaisong Liu - Thomas Jefferson UniversityJames J. Evans - Sidney Kimmel Cancer CenterDavid W. Andrews - Thomas Jefferson University
- Publication Details
- Neurosurgery, v 73(3), pp 489-496
- Publisher
- Oxford Univ Press
- Number of pages
- 8
- Grant note
- P30 CA56036 / Kimmel Cancer Center's NCI Cancer Center P30CA056036 / NATIONAL CANCER INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000330385300023
- Scopus ID
- 2-s2.0-84883285869
- Other Identifier
- 991021897274904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery