title: Does radiation dose to the vestibule predict change in balance function and patient perceived dizziness following stereotactic radiotherapy for vestibular schwannoma?
abstract: OBJECTIVE
  To date, the majority of the vestibular schwannoma (VS) literature has focused on tumor control rates, facial nerve function and hearing preservation. Other factors that have been shown to significantly affect quality-of-life (QOL), such as dizziness, remain understudied. The primary objective of the current study is to investigate the association between radiation dose to the vestibule and post-treatment changes in vestibular function and patient reported dizziness handicap.
  
  
  METHODS
  This is a prospective observational pilot study at a tertiary academic referral center including all subjects that underwent linear accelerator-based stereotactic radiotherapy (SRS) for sporadic VS and completed pre-treatment and post-treatment vestibular testing and Dizziness Handicap Inventory (DHI) questionnaires. Associations between objective vestibular test results, patient-reported DHI scores and radiation dose parameters were investigated.
  
  
  RESULTS
  Ten patients met inclusion criteria. Tumor control was achieved in all individuals. There were no statistically significant associations or identifiable trends between radiation dose and change in vestibular function or DHI scores. Notably, the four ears receiving the highest vestibular dose had minimal changes in vestibular function tests and DHI scores.
  
  
  CONCLUSIONS
  To the best of our knowledge, no previous reports have described the association between radiation dose to the vestibule and post-treatment changes in vestibular function and patient reported DHI. Based on these preliminary data, radiation dose to the vestibule does not reliably predict change in objective or subjective vestibular outcome measures.
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Stavas
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Attia
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Jacobson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rivas
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Morales-Paliza
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: george.wanna@vanderbilt.edu.
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004244:Dizziness / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000532:radiotherapy*; D010865:Pilot Projects; D004856:Postural Balance / Q000528:radiation effects*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D011795:Surveys and Questionnaires; D014724:Vestibular Function Tests; D014722:Vestibule, Labyrinth / Q000528:radiation effects*