Universität zu Köln

Ruess, Daniel, Poehlmann, Lea, Grau, Stefan ORCID: 0000-0002-9742-527X, Hamisch, Christina, Hoevels, Mauritius, Treuer, Harald, Baues, Christian, Kocher, Martin and Ruge, Maximillian (2020). Outcome and toxicity analysis of single dose stereotactic radiosurgery in vestibular schwannoma based on the Koos grading system. Sci Rep, 10 (1). LONDON: NATURE PUBLISHING GROUP. ISSN 2045-2322

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Abstract

Stereotactic radiosurgery (SRS) has evolved as widely accepted treatment option for small-sized (Koos I up to II) vestibular schwannoma (VS). For larger tumors (prevalent Koos VI), microsurgery or combined treatment strategies are mostly recommended. However, in patients not suited for microsurgery, SRS might also be an alternative to balance tumor control, hearing preservation and adverse effects. The purpose of this analysis was to evaluate the efficacy and toxicity of SRS for VS with regard to different Koos grades. All patients with untreated VS who received SRS at our center were included. Outcome analysis included tumor control, preservation of serviceable hearing based on median pure tone averages (PTA), and procedure-related adverse events rated by the Common Terminology Criteria for Adverse Events (CTCAE; v4.03) classification. In total, 258 patients (median age 58 years, range 21-84) were identified with a mean follow-up of 52 months (range 3-228 months). Mean tumor volume was 1.8ml (range 0.1-18.5). The mean marginal dose was 12.3Gy +/- 0.6 (range 11-13.5). The cohort was divided into two groups: A (Koos grades I and II, n=186) and B (Koos grades III and IV, n=72). The actuarial tumor control rate was 98% after 2 years and 90% after 5 and 10 years. Koos grading did not show a significant impact on tumor control (p=0.632) or hearing preservation (p=0.231). After SRS, 18 patients (7%) had new transient or permanent symptoms classified by the CTCAE. The actuarial rate of CTCAE-free survival was not related to Koos grading (p=0.093). Based on this selected population of Koos grade III and IV VS without or with only mild symptoms from brainstem compression, SRS can be recommended as the primary therapy with the advantage of low morbidity and satisfactory tumor control. The overall hearing preservation rate and toxicity of SRS was influenced by age and cannot be predicted by tumor volume or Koos grading alone.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ruess, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Poehlmann, Lea UNSPECIFIED UNSPECIFIED UNSPECIFIED Grau, Stefan UNSPECIFIED orcid.org/0000-0002-9742-527X UNSPECIFIED Hamisch, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoevels, Mauritius UNSPECIFIED UNSPECIFIED UNSPECIFIED Treuer, Harald UNSPECIFIED UNSPECIFIED UNSPECIFIED Baues, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kocher, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruge, Maximillian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-330274
DOI:	10.1038/s41598-020-66213-4
Journal or Publication Title:	Sci Rep
Volume:	10
Number:	1
Date:	2020
Publisher:	NATURE PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	2045-2322
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language GAMMA-KNIFE RADIOSURGERY; TERM-FOLLOW-UP; FACIAL-NERVE PRESERVATION; EVIDENCE-BASED GUIDELINES; HEARING PRESERVATION; TUMOR-CONTROL; SURGERY; MANAGEMENT; MICROSURGERY; PREDICTORS Multiple languages Multidisciplinary Sciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33027