An audiological analysis of stereotactic radiation strategies to preserve hearing in patients with vestibular schwannomas
Shoshana Movsas, Michael Hefferly, Benjamin Movsas and Valerly Shafiro
The purpose of this systematic review was to compare, from an audiological perspective, hearing preservation rates after fractionated stereotactic radiotherapy (FSRT) and stereotactic radiosurgery (SRS) for patients with vestibular schwannomas (VS). A literature review was conducted via Pubmed with the following phrases: radiosurgery, fractionated radiotherapy, vestibular schwannoma and hearing. Of 57 studies identified, six were included in the analysis based on the inclusion and exclusion factors. Tumor control rates were excellent (>90%) for both treatment options. Regarding hearing preservation, three of the six articles reported a significant advantage of FSRT over SRS, while the other three did not find significant differences. The FSRT method may result in higher hearing preservation in selected clinical settings: larger tumors (>3cc), age >55 years, and/or when the SRS dose prescribed was >13 Gy. However, as limitations exist and these studies were not randomized, further studies are needed which incorporate hearing outcomes using enhanced tools. This systematic review can help physicians and patients make more informed decisions regarding radiation treatment options for VS.
Keywords: Vestibular schwannoma, acoustic neuroma, stereotactic radiation, hearing preservation, review, FSRT, SRS