title: Hearing preservation after radiotherapy for vestibular schwannomas is comparable to hearing deterioration in healthy adults and is accompanied by local tumor control and a highly preserved quality of life (QOL) as patients' self-reported outcome.
abstract: OBJECTIVE
  To evaluate long-term results and patients' self-reported outcome of high-precision photon radiotherapy for the treatment of patients with vestibular schwannoma (VS).
  
  
  METHODS
  We treated 246 patients with 248 VS with fractionated stereotactic radiotherapy (FSRT) or stereotactic radiosurgery (SRS). For FSRT, a median total dose of 57.6 Gy was prescribed in median single doses of 1.8 Gy, for SRS, a median dose of 13 Gy/80% isodose was applied. Of all patients, 51 patients died during follow-up. To evaluate long-term toxicity and QOL, we sent out a questionnaire to all living patients; of these, 81 patients (42%) sent back the questionnaire.
  
  
  RESULTS
  Median local control was 84 months, actuarial local control rates for both groups (SRS and FSRT) were 98% after 2, 95% after 5, and 93% after 10 years; there was no statistical difference between FSRT and SRS. Hearing deterioration was significantly higher in the SRS group than the FSRT group. However, when comparing FSRT to SRS with doses ≤ 13 Gy, hearing preservation is comparable. In patients with useful hearing, hearing preservation was 89.7% at 1 year, 84.7% at 3 years, 76.5% at 5 years, and 68.6% at 10 years. After 10 years of follow-up, hearing deterioration can be observed in both subgroups. In the FSRT group, facial nerve toxicity rate was 1.6%. Trigeminal nerve toxicity was observed in 2.1% after FSRT. Overall QOL was unchanged in 47% of the patients after RT, and 31% reported an improvement in QOL during follow-up.
  
  
  CONCLUSIONS
  Patients' self-reported outcome confirms good results with respect to tumor control and QOL after FSRT or SRS in patients with VS. SRS can be associated with higher side effect following a dose-dependency. In long-term follow-up, hearing deterioration is most likely attributed to normal aging, but not treatment-related.
authors: Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany. Stephanie.combs@med.uni-heidelberg.de
authors: Stephanie E
authors: SE
authors: Combs
authors: Thomas
authors: T
authors: Welzel
authors: Kerstin
authors: K
authors: Kessel
authors: Daniel
authors: D
authors: Habermehl
authors: Stefan
authors: S
authors: Rieken
authors: Oliver
authors: O
authors: Schramm
authors: Jürgen
authors: J
authors: Debus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005154:Facial Nerve / Q000528:radiation effects; D005260:Female; D006309:Hearing / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects*; D057566:Self Report; D014276:Trigeminal Nerve / Q000528:radiation effects