Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results

doi:10.1016/0167-8140(93)90127-T

Radiotherapy and Oncology

Volume 27, Issue 2, May 1993, Pages 91-98

https://doi.org/10.1016/0167-8140(93)90127-T Get rights and content

Abstract

In order to evaluate the results of radiosurgery for acoustic tumors and to identify optimum treatment parameters, an analysis of tumor control, as well as incidences of hearing loss, facial and trigeminal neuropathies was undertaken. Between August 1987 and August 1991, 134 patients with 136 acoustic tumors received stereotactic gamma knife radiosurgery at the University of Pittsburgh. Median follow-up was 24 months (range: 6–56 months). Tumor volumes ranged from 0.10 to 17.00 cm³ (median = 2.75 cm³). From one to ten isocenters were utilized per tumor treated (median = 3). Minimum tumor doses varied from 12 to 20 Gy (median = 17 Gy). The 4-year actuarial tumor control rate was 89.2 ± 6.0%. Some degree of hearing (by pure tone audiometry) was preserved in 71.0 ± 4.4% of patients. The actuarial rates for preservation of either pretreatment hearing level or useful hearing. were 34.4 ± 6.6% and 35.1 ± 97% respectively. Respectively, the actuarial incidences of postradiosurgery facial and trigeminal neuropathies were 29.0 ± 4.4% and 32.9 ± 4.5%, respectively. No significant factors affecting tumor control were identified. Multivariate analysis identified a significantly increased risk of hearing loss in patients with neurofibromatosis (p = 0.0003) as well as decreased risks of facial and trigeminal neuropathies with both decreasing tumor diameter (p = 0.001) and increasing number of isocenters treated (p = 0.003). Radiosurgery is a safe and effective treatment for acoustic neuromas with acceptable morbidity that may be lowered by the use of multiple isocenter treatment techniques and by earlier treatment of small tumors.

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GKSRS yielded local control of 5, 10, and 15 years at 96.9%, 90.0%, and 87.1% respectively. Pseudoprogression was found in 45%, with a novel pattern detected with peak swelling at 31 months. Pseudoprogression was associated with smaller tumor diameter at treatment and fewer treatment isocenters, but not with the development of any toxicity, nor was it predicted by any dosimetric factor. Median time to hearing loss was 3.4 years with actuarial hearing preservation at 2, 5, and 10 years of 66.5%, 43.1%, and 37.6%, with rate of hearing loss correlating with maximum cochlea and modiolus doses. Trigeminal and facial nerve preservation rates were 92.7% and 97.6%, respectively. Increasing maximum tumor dose was associated with facial paresthesia.
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Citation Excerpt :
Lowering of the marginal dose lead to a significant decrease in CN complications.20 For example, Flickinger et al.15 in their early series found a rate of CN V and VII impairment exceeding 32% and 29%, respectively, using a median marginal dose of 17 Gy. In their recent series,26 the rates were considerably lower than 3% when using a median margin dose as low as 13 Gy, as we did in our series.
To determine the clinical and radiologic outcome of patients with acoustic neuroma (AN) treated with linear accelerator (LINAC) or CyberKnife-based stereotactic radiosurgery with respect to tumor control, preservation of serviceable hearing, and toxicity.
A retrospective monocentric analysis including all patients who underwent single-fraction LINAC- or CyberKnife-based radiosurgery for AN between 1991 and 2015. Patient data were analyzed in terms of radiologic and clinical tumor control (no further intervention needed), treatment-related complications, preservation of serviceable hearing, and objectified hearing loss using pure tone average levels.
We included 335 patients (median age 58.2 years, treated either by LINAC-based [n = 270] or CyberKnife [n = 65] stereotactic radiosurgery). The median tumor volume was 1.1 mL (0.1–23.7 mL). The median radiation dose was 12 Gy (LINAC 12 Gy, 11–20 Gy; CyberKnife 13 Gy, 12–13 Gy) at an isodose level of 71.7% (LINAC 68.3%, 31.9%–86.2%; CyberKnife 80%, 65%–81%). The median follow-up was 30 months (LINAC 43 months, 2–224 months; CyberKnife 13 months, 4–37 months). Clinical tumor control was 98%, 89%, and 88% at 2, 5, and 10 years. The objective actuarial hearing preservation rate was 89%, 80%, and 55% at 1, 2, and 5 years. New symptoms were observed in 11.3% and classified as Common Terminology Criteria for Adverse Events grade 1/2, apart from 4 patients (1.2%), who developed Common Terminology Criteria for Adverse Events grade 3.
Our study shows that in AN, high tumor control and considerable hearing preservation rates can be achieved by single-dose radiosurgery at low toxicity rates, resulting in a positive impact on long-term clinical outcome.

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Original paperGamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results

Abstract

Surg. Neurol.

Int. J. Radiat. Oncol., Biol. Phys.

Neurosurg. Clin. North Am.

Int. J. Radiat. Oncol., Biol. Phys.

Radiother. Oncol.

Acoustic neuroma surgery: An eclectic approach with emphasis on preservation of hearing

Ann. Otol., Rhinol., Laryngol.

Regression models and life tables

J. R. Stat. Soc., B.

A critical comparison of neurosurgical and otolaryngological approaches to acoustic neuromas

J. Neurosurg.

Dose prescription and dose volume effects in radiosurgery

Neurosurg. Clin. North Am.

Radiosurgery of acoustic neurinomas

Cancer

Hearing preservation after acoustic neurinoma operation

Neurosurgery

Middle cranial fossa acoustic neuroma excision: Results and complications

Ann. Otol., Rhinol., Laryngol.

Hearing preservation in unilateral acoustic neuroma surgery

Ann. Otol., Rhinol., Laryngol.

A systematic approach to the surgical management of acoustic neuroma

Laryngoscope

Facial nerve grading system

Otolaryngeal Head Neck Surg.

Original paper
Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results