Hearing preservation in patients with unilateral vestibular schwannoma who undergo stereotactic radiosurgery: Reinterpretation of the auditory brainstem response.

Abstract

BACKGROUND:

The objective of this study was to identify the prognostic factors for hearing preservation that would allow the more accurate stratification of patients who undergo stereotactic radiosurgery (SRS) for unilateral, sporadic vestibular schwannoma (VS).

METHODS:

In total, 119 patients with VS who had serviceable hearing underwent SRS as primary treatment. The mean (±standard deviation) patient age was 48 ± 11 years, and the mean (±standard deviation) follow-up duration was 55.2 ± 35.7 months. The median marginal radiotherapy dose was 12.0 grays (Gy), and the mean (±standard deviation) tumor volume was 1.95 ± 2.24 cm(3) . The mean (±standard deviation) pure tone average (PTA) score was 26 ± 12 decibels (dB) (range, 4-50 dB), and the mean (±standard deviation) maximum speech discrimination score was 91 ± 12% (range, 52-100%). The mean (±standard deviation) baseline values for the interlatency (IL) of waves I and III (IL I-III) and the IL of waves I through V (IL I-V) on auditory brainstem response were 2.58 ± 0.60 milliseconds (mS) (range, 1.92-4.30 mS) and 4.80 ± 0.61 mS (range, 3.80-6.40 mS), respectively.

RESULTS:

In multivariate analysis, the PTA score and IL I-V were significant and independent prognostic factors (hazard ratio, 1.072; 95% confidence interval, 1.046-1.098; P < .001; and hazard ratio, 1.534; 95% confidence interval, 1.008-2.336; P = .046, respectively). By using the PTA score and IL I-V, the patients were classified into 4 groups. The ratios of patients with serviceable hearing after SRS were 89.6%, 64.0%, 25.8%, and 6.7%, respectively, in Groups A through D (P < .001).

CONCLUSIONS:

The current results indicated that the classification system based on using the PTA score and the IL I-V of the auditory brainstem response may be useful and specific for predicting the rate of hearing preservation in each individual.

• Authors: Jung Ho Han, Dong Gyu Kim, Hyun-Tai Chung, Sun Ha Paek, Chul-Kee Park, Chae-Yong Kim, Young-Hoon Kim, Jin Wook Kim, Yong Hwy Kim, Sang Woo Song, In Kyung Kim, Hee-Won Jung
• Journal: Cancer (Cancer) Vol. 118 Issue 21 Pg. 5441-7 (Nov 01 2012) ISSN: 1097-0142 [Electronic] United States
• PMID: 22570121 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 American Cancer Society.

Topics

• Adult
• Evoked Potentials, Auditory, Brain Stem
• Female
• Hearing Loss (etiology)
• Humans
• Male
• Middle Aged
• Neuroma, Acoustic (surgery)
• Prognosis
• Radiosurgery (adverse effects)