Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Int Adv Otol. 2021 Sep;17(5):426-432. doi: 10.5152/iao.2021.21004.
To report our results on hearing preservation after linear accelerator (LINAC)-based stereotactic radiotherapy for vestibular schwannomas (VS) in a tertiary referral center.
All patients who presented with VS in our center between 2010 and 2018 and who were treated with LINAC-based radiotherapy were retrospectively analyzed. Pure tone average and speech discrimination score represented hearing outcome, pre- and postradiotherapy. A Gardner-Robertson grade I or II hearing represented functional hearing.
In total, 35 patients were treated with LINAC-based radiotherapy. Median age was 55 years (range 18-86 years), 22 (63%) were female. Sixteen patients had a Koos grade III or IV tumor. Twenty-four patients were treated with radiosurgery (1 or 5 fractions; stereotactic radiosurgery), and eleven patients were treated with fractionated stereotactic radiotherapy. Mean follow-up was 4.8 years (range 1.8-8.4 years). In 34 patients, hearing was assessed pre- and post-radiotherapy. In seventeen patients, hearing remained stable. In eleven patients, a decrease in GR scale was observed, of which seven patients showed a decrease from a functional to a non-functional level (4 GR III, 2 GR IV, and 1 GR V). Tumor control was 95% (34/35), and except for hearing loss, all post-radiation complications and morbidity were transient.
These data emphasize that although the rate of tumor control (the primary goal of radiotherapeutic treatment) is high, it is important to adequately manage patients' expectations regarding the outcomes of the secondary possibly positive outcome; hearing preservation.
报告我们在一家三级转诊中心使用直线加速器（LINAC）立体定向放射治疗前庭神经鞘瘤（VS）后保留听力的结果。
回顾性分析 2010 年至 2018 年期间在我中心就诊并接受 LINAC 放疗的所有 VS 患者。纯音平均听力和言语辨别评分代表放疗前后的听力结果。听力功能良好（Gardner-Robertson 分级 I 或 II）。
共 35 例患者接受 LINAC 立体定向放疗。中位年龄为 55 岁（18-86 岁），22 例（63%）为女性。16 例患者 Koos 分级为 III 或 IV 级肿瘤。24 例患者接受立体定向放射外科治疗（1 或 5 个剂量；立体定向放射外科），11 例患者接受分次立体定向放疗。平均随访时间为 4.8 年（1.8-8.4 年）。34 例患者接受了放疗前后的听力评估。17 例患者听力稳定。11 例患者听力下降，其中 7 例从功能性听力下降到非功能性听力（4 级 III、2 级 IV 和 1 级 V）。肿瘤控制率为 95%（34/35），除听力损失外，所有放疗后并发症和发病率均为暂时性的。
这些数据强调，尽管肿瘤控制率（放射治疗的主要目标）较高，但重要的是要充分管理患者对继发性可能阳性结果（听力保留）的结果的期望。
