UCLA Department of Neurosurgery, University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1761, USA.
J Clin Neurosci. 2012 Aug;19(8):1065-70. doi: 10.1016/j.jocn.2012.01.015. Epub 2012 Jun 15.
Linear accelerators (LINAC) can deliver both radiosurgery and fractionated radiotherapy. In this systematic analysis, we compare hearing preservation in patients with vestibular schwannomas (VS) treated with either LINAC-based radiotherapy (SRT) or LINAC-based radiosurgery (SRS), with an emphasis on the prognostic implications of tumor size and patient age. A total of 400 patients met our criteria for LINAC SRS, with an average hearing preservation rate of 66.3%. Patients with smaller tumors (<3.0 cm(3)) treated with SRS had similar hearing preservation rates to those with larger tumors. However, younger patients (<55 years) demonstrated improved hearing preservation compared to older patients (≥55 years). When comparing LINAC SRS to LINAC SRT directly, hearing preservation was similar in patients with smaller tumors. However, patients with larger tumors (≥3.0cm(3)) who received SRT had higher hearing preservation rates than those who received SRS. A total of 629 patients met our criteria for LINAC SRT, with an average hearing preservation rate of 75.3%. Patients with larger tumors who received SRT had better hearing outcomes than those with smaller tumors, while there was no significant difference in hearing preservation in younger patients compared to older patients. When comparing LINAC SRS to LINAC SRT directly, younger patients had similar hearing preservation rates. However, older patients who received SRT had improved hearing preservation compared to those who received SRS. In a direct comparison of average hearing preservation, patients who received SRT had higher hearing preservation rates than those who underwent SRS. Prospective studies will be needed to further characterize radiation dose and other variables.
直线加速器 (LINAC) 既能提供放射外科治疗，也能提供分割放疗。在这项系统分析中，我们比较了采用 LINAC 放疗 (SRT) 或 LINAC 放射外科治疗 (SRS) 治疗前庭神经鞘瘤 (VS) 患者的听力保留情况，重点关注肿瘤大小和患者年龄的预后意义。共有 400 名符合我们 LINAC SRS 标准的患者，平均听力保留率为 66.3%。接受 SRS 治疗的较小肿瘤 (<3.0cm³) 的患者与接受较大肿瘤治疗的患者具有相似的听力保留率。然而，年轻患者 (<55 岁) 的听力保留率优于老年患者 (≥55 岁)。将 LINAC SRS 与 LINAC SRT 直接比较时，较小肿瘤患者的听力保留率相似。然而，接受 SRT 治疗的较大肿瘤 (≥3.0cm³) 的患者的听力保留率高于接受 SRS 治疗的患者。共有 629 名符合我们 LINAC SRT 标准的患者，平均听力保留率为 75.3%。接受 SRT 治疗的较大肿瘤患者的听力预后优于较小肿瘤患者，而年轻患者与老年患者在听力保留方面没有显著差异。将 LINAC SRS 与 LINAC SRT 直接比较时，年轻患者的听力保留率相似。然而，接受 SRT 治疗的老年患者的听力保留率优于接受 SRS 治疗的患者。在平均听力保留的直接比较中，接受 SRT 治疗的患者的听力保留率高于接受 SRS 治疗的患者。需要前瞻性研究进一步确定辐射剂量和其他变量的作用。
