Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods

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Object. The goal of this study was to define tumor control and complications of radiosurgery encountered using current treatment methods for the initial management of patients with unilateral acoustic neuroma.

Methods. One hundred ninety patients with previously untreated unilateral acoustic neuromas (vestibular schwannomas) underwent gamma knife radiosurgery between 1992 and 1997. The median follow-up period in these patients was 30 months (maximum 85 months). The marginal radiation doses were 11 to 18 Gy (median 13 Gy), the maximum doses were 22 to 36 Gy (median 26 Gy), and the treatment volumes were 0.1 to 33 cm3 (median 2.7 cm3).

The actuarial 5-year clinical tumor-control rate (no requirement for surgical intervention) for the entire series was 97.1 ± 1.9%. Five-year actuarial rates for any new facial weakness, facial numbness, hearing-level preservation, and preservation of testable speech discrimination were 1.1 ± 0.8%, 2.6 ± 1.2%, 71 ± 4.7%, and 91 ± 2.6%, respectively. Facial weakness did not develop in any patient who received a marginal dose of less than 15 Gy (163 patients). Hearing levels improved in 10 (7%) of 141 patients who exhibited decreased hearing (Gardner-Robertson Classes II–V) before undergoing radiosurgery. According to multivariate analysis, increasing marginal dose correlated with increased development of facial weakness (p = 0.0342) and decreased preservation of testable speech discrimination (p = 0.0122).

Conclusions. Radiosurgery for acoustic neuroma performed using current procedures is associated with a continued high rate of tumor control and lower rates of posttreatment morbidity than those published in earlier reports.

Article Information

Address reprint requests to: John C. Flickinger, M.D., Joint Radiation Oncology Center, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. email: jflickin@pop.pitt.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph demonstrating actuarial tumor control for 190 patients who underwent stereotactic radiosurgery for previously untreated unilateral acoustic neuromas. Clinical tumor control or resection-free survival was defined as the absence of significant or sustained tumor growth not requiring surgery. Neuroimaging-determined tumor control was defined as the absence of any documented 1- to 2-mm change in tumor diameter on MR images (including temporary changes), whether it was sustained or required surgical intervention.

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    Graph showing actuarial rates of developing facial numbness (trigeminal neuropathy) or facial weakness after radiosurgery for acoustic neuroma in 190 patients.

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    Graph showing a comparison of actuarial freedom from developing facial weakness (facial neuropathy) after radiosurgery for acoustic neuroma in patients who received marginal tumor doses of 13 Gy or less compared with those who received doses of 14 Gy or more.

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    Graph depicting actuarial hearing preservation rates postradiosurgery in 137 patients who had testable hearing (Gardner—Robertson [GR] Class I–IV) before radiosurgery for acoustic neuroma (75 assessable patients with Class I–II hearing). Hearing preservation was classified as any testable speech discrimination remaining, serviceable hearing (Gardner—Robertson Class I–II) remaining, and preservation of the same Gardner—Robertson hearing level.

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