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

Steven D Chang; Alexander Muacevic; Andrea L Klein; Jonathan H Sherman; Pantaleo Romanelli; Peter L Santa Maria; Christoph Fuerweger; Isa Bossi Zanetti; Giancarlo Beltramo; Yona Vaisbush; Emma Tran; Austin Feng; Hao Teng; Antonio Meola; Iris Gibbs; Antony M Tolisano; Joe Walter Kutz Jr; Zabi Wardak; Lucien A Nedzi; Robert Hong; Don MacRae; Preet Sohal; Elina Kapoor; Parisa Sabet-Rasekh; Sam Maghami; Paola X Moncada; Ashley Zaleski-King; Richard Amdur; Ashkan Monfared

doi:10.1016/j.wneu.2023.05.098

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

World Neurosurg. 2023 Oct:178:e24-e33. doi: 10.1016/j.wneu.2023.05.098. Epub 2023 Jun 1.

Authors

Steven D Chang¹, Alexander Muacevic², Andrea L Klein³, Jonathan H Sherman⁴, Pantaleo Romanelli⁵, Peter L Santa Maria⁶, Christoph Fuerweger², Isa Bossi Zanetti⁵, Giancarlo Beltramo⁵, Yona Vaisbush⁷, Emma Tran⁸, Austin Feng⁸, Hao Teng⁹, Antonio Meola¹, Iris Gibbs¹⁰, Antony M Tolisano¹¹, Joe Walter Kutz Jr¹², Zabi Wardak¹³, Lucien A Nedzi¹³, Robert Hong¹⁴, Don MacRae¹⁴, Preet Sohal¹⁵, Elina Kapoor¹⁵, Parisa Sabet-Rasekh¹⁶, Sam Maghami¹⁶, Paola X Moncada¹⁶, Ashley Zaleski-King¹⁶, Richard Amdur¹⁷, Ashkan Monfared¹⁸

Affiliations

¹ Department of Neurosurgery, Stanford University, Stanford, California, USA.
² European Cyberknife Center, Munich, Germany.
³ The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: andreaklein@gwu.edu.
⁴ Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
⁵ Cyberknife Center, Centro Diagnostico Italiano, Milan, Italy.
⁶ Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, California, USA.
⁷ Technion, Haifa, Israel.
⁸ Stanford University School of Medicine, Stanford, California, USA.
⁹ Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
¹⁰ Department of Radiation Oncology, Stanford University, Stanford, California, USA.
¹¹ Department of Otolaryngology, Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
¹² Department of Otolaryngology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹³ Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁴ Virginia Hospital Center, Arlington, Virginia, USA.
¹⁵ The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
¹⁶ Division of Otolaryngology - Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
¹⁷ Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
¹⁸ 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.

PMID: 37268187
DOI: 10.1016/j.wneu.2023.05.098

Abstract

Objective: 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. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment 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 (PTAs) increased and word recognition scores (WRSs) 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.

Conclusions: Decline of hearing at one 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 hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.

Keywords: Fractionation; Hearing preservation; Radiation dose; Stereotactic radiosurgery; Vestibular schwannoma.

Publication types

Multicenter Study

MeSH terms

Follow-Up Studies
Hearing
Humans
Neuroma, Acoustic* / radiotherapy
Neuroma, Acoustic* / surgery
Radiosurgery* / adverse effects
Radiosurgery* / methods
Retrospective Studies
Treatment Outcome