Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas.
OBJECTIVE
The best management strategy for small-to medium-sized vestibular schwannomas (VSs) remains controversial between observation, radiation, and microsurgical resection (surgery). The authors undertook a prospective observational cohort study comparing all 3 therapeutic modalities in patients with VSs, focusing on quality of life (QOL) outcomes.


METHODS
All patients in the study completed the 36-Item Short Form Health Survey at regular intervals, with a mean follow-up of 31.8 months. Two hundred five (77.7%) of 264 patients completed questionnaires, including 47 who underwent observation, 48 who received either linear accelerator radiosurgery or fractionated radiotherapy (radiation group), and 134 who underwent surgery (of whom 37 had tumors > 3 cm in diameter). Patients allocated to the observation group had smaller tumors than those in the other groups (mean 1.3 cm; p < 0.001). Patients who received radiation were older than patients in the other groups (mean 60.0 years; p < 0.001).


RESULTS
There were no baseline QOL differences between the observation, radiation, and surgery (tumors <or= 3 cm) groups. Quality of life remained unchanged for the observation and radiation groups throughout the follow-up period. In the surgery group with tumors <or= 3 cm, a significant improvement in total score and composite mental dimension was observed at 24 months. In the surgery group with tumors > 3 cm, there was an early improvement in composite mental dimension at 1.5 months, as well as at 24 months; total score and composite physical dimension were improved at 24 months in this group as well.


CONCLUSIONS
Based on the current management protocol, patients with VSs enjoy similar QOL throughout the follow-up period after undergoing observation, radiation therapy, or surgery.
Di Maio
Salvatore
S
Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Akagami
Ryojo
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods; D011878:Radiotherapy / Q000379:methods; D015983:Selection Bias; D011795:Surveys and Questionnaires; D016896:Treatment Outcome