Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
Radiother Oncol. 2013 Feb;106(2):175-80. doi: 10.1016/j.radonc.2012.12.004. Epub 2013 Jan 17.
To evaluate long-term results and patients' self-reported outcome of high-precision photon radiotherapy for the treatment of patients with vestibular schwannoma (VS).
We treated 246 patients with 248 VS with fractionated stereotactic radiotherapy (FSRT) or stereotactic radiosurgery (SRS). For FSRT, a median total dose of 57.6 Gy was prescribed in median single doses of 1.8 Gy, for SRS, a median dose of 13 Gy/80% isodose was applied. Of all patients, 51 patients died during follow-up. To evaluate long-term toxicity and QOL, we sent out a questionnaire to all living patients; of these, 81 patients (42%) sent back the questionnaire.
Median local control was 84 months, actuarial local control rates for both groups (SRS and FSRT) were 98% after 2, 95% after 5, and 93% after 10 years; there was no statistical difference between FSRT and SRS. Hearing deterioration was significantly higher in the SRS group than the FSRT group. However, when comparing FSRT to SRS with doses ≤ 13 Gy, hearing preservation is comparable. In patients with useful hearing, hearing preservation was 89.7% at 1 year, 84.7% at 3 years, 76.5% at 5 years, and 68.6% at 10 years. After 10 years of follow-up, hearing deterioration can be observed in both subgroups. In the FSRT group, facial nerve toxicity rate was 1.6%. Trigeminal nerve toxicity was observed in 2.1% after FSRT. Overall QOL was unchanged in 47% of the patients after RT, and 31% reported an improvement in QOL during follow-up.
Patients' self-reported outcome confirms good results with respect to tumor control and QOL after FSRT or SRS in patients with VS. SRS can be associated with higher side effect following a dose-dependency. In long-term follow-up, hearing deterioration is most likely attributed to normal aging, but not treatment-related.
评估高精准光子放疗治疗前庭神经鞘瘤（VS）患者的长期疗效和患者报告的结果。
我们采用分次立体定向放疗（FSRT）或立体定向放射外科（SRS）治疗 246 例 248 个 VS 患者。FSRT 中，中位总剂量 57.6Gy，单次中位剂量 1.8Gy；SRS 中，中位剂量 13Gy/80%等剂量线。所有患者随访期间 51 例死亡。为了评估长期毒性和生活质量，我们向所有存活患者发送了一份问卷；其中 81 例（42%）患者返回了问卷。
中位局部控制时间为 84 个月，两组（SRS 和 FSRT）的局部控制率分别为：2 年时为 98%，5 年时为 95%，10 年时为 93%；FSRT 和 SRS 之间无统计学差异。SRS 组听力下降明显高于 FSRT 组。然而，当将 FSRT 与剂量≤13Gy 的 SRS 比较时，听力保护是相当的。在有有用听力的患者中，1 年时听力保护率为 89.7%，3 年时为 84.7%，5 年时为 76.5%，10 年时为 68.6%。10 年随访时，两个亚组均可观察到听力下降。FSRT 组面神经毒性发生率为 1.6%。FSRT 后三叉神经毒性发生率为 2.1%。RT 后 47%的患者总体生活质量保持不变，31%的患者报告生活质量在随访期间有所改善。
患者报告的结果证实，FSRT 或 SRS 治疗 VS 患者的肿瘤控制和生活质量均有良好的效果。SRS 可能与剂量依赖性的更高副作用相关。在长期随访中，听力下降最有可能归因于正常衰老，而不是与治疗相关。
