title: Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls.
abstract: OBJECTIVE
  The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument.
  
  
  METHODS
  All patients with sporadic small- to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison.
  
  
  RESULTS
  A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures.
  
  
  CONCLUSIONS
  The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not confer a long-term HRQOL advantage, small- and medium-sized VS should be initially observed, while intervention should be reserved for patients with unequivocal tumor growth or intractable symptoms that are amenable to treatment. Future studies assessing HRQOL in VS patients should prioritize use of validated disease-specific measures, such as the PANQOL, given the significant limitations of generic instruments in distinguishing between treatment groups and tumor versus nontumor subjects.
authors.affiliation: Departments of 1 Otolaryngology-Head and Neck Surgery and.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Oystein Vesterli
authors.initials: OV
authors.lastname: Tveiten
authors.forename: Colin L
authors.initials: CL
authors.lastname: Driscoll
authors.forename: Frederik K
authors.initials: FK
authors.lastname: Goplen
authors.forename: Brian A
authors.initials: BA
authors.lastname: Neff
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Pollock
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tombers
authors.forename: Marina L
authors.initials: ML
authors.lastname: Castner
authors.forename: Monica K
authors.initials: MK
authors.lastname: Finnkirk
authors.forename: Erling
authors.initials: E
authors.lastname: Myrseth
authors.forename: Paal-Henning
authors.initials: PH
authors.lastname: Pedersen
authors.forename: Morten
authors.initials: M
authors.lastname: Lund-Johansen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
mesh_terms: D000368:Aged; D001299:Audiometry; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D020220:Facial Nerve Injuries / Q000453:epidemiology / Q000628:therapy; D005260:Female; D023261:Glasgow Outcome Scale; D006309:Hearing; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome
keywords: AAO-HNS = American Academy of Otolaryngology-Head and Neck Surgery; CPA = cerebellopontine angle; GBI = Glasgow Benefit Inventory; Gamma Knife radiosurgery; HRQOL = health-related quality of life; IQR = interquartile range; MCID = minimum clinically important difference; PANQOL = Penn Acoustic Neuroma Quality-of-Life; PROMIS-10 = 10-item Patient-Reported Outcomes Measurement Information System; SF-36 = 36-Item Short Form Health Survey; SRS = stereotactic radiosurgery; VS = vestibular schwannoma; acoustic neuroma; cerebellopontine angle; microsurgery; quality of life; stereotactic radiosurgery; vestibular schwannoma