立体定向放射外科或分次立体定向放射治疗前庭神经鞘瘤的听力保护。
Hearing Preservation for Vestibular Schwannomas Treated with Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy.
机构信息
Department of Neurosurgery, University of California, Los Angeles, California, USA; David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Department of Neurosurgery, University of California, Los Angeles, California, USA.
出版信息
World Neurosurg. 2019 Sep;129:e303-e310. doi: 10.1016/j.wneu.2019.05.133. Epub 2019 May 24.
BACKGROUND
Vestibular schwannomas (VS) are benign intracranial neoplasms arising from the eighth cranial nerve for which targeted radiation therapy (RT) has proved increasingly successful. However, long-term hearing and related cranial nerve outcomes have been disputed for the 3 current RT modalities.
OBJECTIVE
To determine differences in hearing preservation for patients treated with stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), or hypofractionated stereotactic radiotherapy (hypoFSRT) for VS.
METHODS
A retrospective electronic chart review was conducted for all patients with unilateral VS treated with primary RT at a single academic medical center between 2000 and 2017. The primary outcome measure was preservation of serviceable hearing status in the affected ear at last follow-up. Secondary outcomes included tinnitus, vertigo, and imbalance.
RESULTS
A total of 33 FSRT cases, 21 SRS cases, and 6 hypoFSRT cases were identified. Postoperative deterioration in serviceable hearing and tinnitus showed significant differences across cohorts. The SRS cohort had a higher baseline incidence of nonserviceable hearing and disequilibrium compared with other cohorts before RT (P = 0.001 and 0.022, respectively); no differences in baseline morbidity were observed for vertigo and tinnitus. The 5-year tumor control rate was 95.2%, 93.9%, and 100% with SRS, FSRT, and hypoFSRT, respectively.
CONCLUSIONS
Our series indicated an excellent tumor control rate in all the modalities. Our SRS cohort showed increased incidence and shorter time to hearing deterioration compared with the FSRT and hypoFSRT cohorts. The FSRT and hypoFSRT cohorts have shown comparable overall outcomes. Onset of post-RT tinnitus was observed only with FSRT.
背景
前庭神经鞘瘤（VS）是起源于第八颅神经的良性颅内肿瘤，靶向放射治疗（RT）已被证明越来越成功。然而，对于目前的 3 种 RT 模式，长期听力和相关颅神经的结果仍存在争议。
目的
确定接受立体定向放射外科手术（SRS）、分次立体定向放射治疗（FSRT）或低分割立体定向放射治疗（hypoFSRT）治疗 VS 的患者在听力保留方面的差异。
方法
对 2000 年至 2017 年期间在一家学术医疗中心接受原发性 RT 治疗的单侧 VS 患者进行回顾性电子病历回顾。主要观察指标为最后一次随访时受影响耳的可保留听力状态。次要结果包括耳鸣、眩晕和失衡。
结果
共发现 33 例 FSRT 病例、21 例 SRS 病例和 6 例 hypoFSRT 病例。术后可保留听力和耳鸣的恶化在不同队列之间有显著差异。与其他队列相比，SRS 队列在 RT 前具有更高的基线不可用听力和失衡发生率（P = 0.001 和 0.022）；眩晕和耳鸣的基线发病率无差异。SRS、FSRT 和 hypoFSRT 的 5 年肿瘤控制率分别为 95.2%、93.9%和 100%。
结论
我们的系列研究表明，所有治疗模式均具有出色的肿瘤控制率。与 FSRT 和 hypoFSRT 队列相比，我们的 SRS 队列显示出更高的发病率和听力恶化的时间更短。FSRT 和 hypoFSRT 队列具有相似的总体结果。仅在 FSRT 中观察到 RT 后耳鸣的发生。
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