Abstract：
OBJECTIVE: The present study assesses the safety and efficacy of stereotactic radiosurgery (SRS) versus observation for Koos grade 1 and 2 vestibular schwannoma (VS), benign tumors affecting hearing and neurological function.
METHODS: This multicenter study analyzed data from Koos grade 1 and 2 VS patients managed with SRS (SRS group) or observation (observation group). Propensity score matching balanced patient demographics, tumor volume, and audiometry. Outcomes measured were tumor control, serviceable hearing preservation, and neurological outcomes.
RESULTS: In 125 matched patients in each group with a 36-month median follow-up (P = .49), SRS yielded superior 5- and 10-year tumor control rates (99% CI, 97.1%-100%, and 91.9% CI, 79.4%-100%) versus observation (45.8% CI, 36.8%-57.2%, and 22% CI, 13.2%-36.7%; P < .001). Serviceable hearing preservation rates at 5 and 9 years were comparable (SRS 60.4% CI, 49.9%-73%, vs observation 51.4% CI, 41.3%-63.9%, and SRS 27% CI, 14.5%-50.5%, vs observation 30% CI, 17.2%-52.2%; P = .53). SRS were associated with lower odds of tinnitus (OR = 0.39, P = .01), vestibular dysfunction (OR = 0.11, P = .004), and any cranial nerve palsy (OR = 0.36, P = .003), with no change in cranial nerves 5 or 7 (P > .05). Composite endpoints of tumor progression and/or any of the previous outcomes showed significant lower odds associated with SRS compared with observation alone (P < .001).
CONCLUSIONS: SRS management in matched cohorts of Koos grade 1 and 2 VS patients demonstrated superior tumor control, comparable hearing preservation rates, and significantly lower odds of experiencing neurological deficits. These findings delineate the safety and efficacy of SRS in the management of this patient population.
METHODS: This multicenter study analyzed data from Koos grade 1 and 2 VS patients managed with SRS (SRS group) or observation (observation group). Propensity score matching balanced patient demographics, tumor volume, and audiometry. Outcomes measured were tumor control, serviceable hearing preservation, and neurological outcomes.
RESULTS: In 125 matched patients in each group with a 36-month median follow-up (P = .49), SRS yielded superior 5- and 10-year tumor control rates (99% CI, 97.1%-100%, and 91.9% CI, 79.4%-100%) versus observation (45.8% CI, 36.8%-57.2%, and 22% CI, 13.2%-36.7%; P < .001). Serviceable hearing preservation rates at 5 and 9 years were comparable (SRS 60.4% CI, 49.9%-73%, vs observation 51.4% CI, 41.3%-63.9%, and SRS 27% CI, 14.5%-50.5%, vs observation 30% CI, 17.2%-52.2%; P = .53). SRS were associated with lower odds of tinnitus (OR = 0.39, P = .01), vestibular dysfunction (OR = 0.11, P = .004), and any cranial nerve palsy (OR = 0.36, P = .003), with no change in cranial nerves 5 or 7 (P > .05). Composite endpoints of tumor progression and/or any of the previous outcomes showed significant lower odds associated with SRS compared with observation alone (P < .001).
CONCLUSIONS: SRS management in matched cohorts of Koos grade 1 and 2 VS patients demonstrated superior tumor control, comparable hearing preservation rates, and significantly lower odds of experiencing neurological deficits. These findings delineate the safety and efficacy of SRS in the management of this patient population.
摘要：
背景：本研究评估了立体定向放射外科（SRS）与观察KoosI级和II级前庭神经鞘瘤（VS）的安全性和有效性，影响听力和神经功能的良性肿瘤。
方法：这项多中心研究分析了接受SRS（SRS组）或观察（观察组）的KoosI级和II级VS患者的数据。倾向评分匹配平衡的患者人口统计数据，肿瘤体积,和测听法。测量的结果是肿瘤控制，可使用的听力保护（SHP），和神经系统的结果。
结果：在每组125名匹配患者中，中位随访时间为36个月（p=0.49），SRS的5年和10年肿瘤控制率较高(99%，CI：97.1%-100%，91.9%,CI：79.4%-100%）与观察(45.8%，CI：36.8%-57.2%，22%,CI：13.2%-36.7%；p<0.001）。5年和9年的SHP率相当(SRS60.4%，CI：49.9%-73%，vs.观察51.4%，CI：41.3%-63.9%，和SRS27%，CI：14.5%-50.5%，vs.观察30%,CI：17.2%-52.2%；p=0.53）。SRS与较低的耳鸣几率相关(OR=0.39,p=0.01),前庭功能障碍（OR=0.11，p=0.004），和任何颅神经麻痹（OR=0.36，p=0.003），颅神经V或VII无变化（p>0.05）。与单独观察相比，肿瘤进展和/或任何先前结果的复合终点显示出与SRS相关的显著较低的几率(p<0.001)。
结论：在KoosI级和II级VS患者的配对队列中，SRS管理显示出更好的肿瘤控制，相当的听力保持率，并且出现神经功能缺损的几率大大降低。这些发现描述了SRS在该患者人群管理中的安全性和有效性。
方法：这项多中心研究分析了接受SRS（SRS组）或观察（观察组）的KoosI级和II级VS患者的数据。倾向评分匹配平衡的患者人口统计数据，肿瘤体积,和测听法。测量的结果是肿瘤控制，可使用的听力保护（SHP），和神经系统的结果。
结果：在每组125名匹配患者中，中位随访时间为36个月（p=0.49），SRS的5年和10年肿瘤控制率较高(99%，CI：97.1%-100%，91.9%,CI：79.4%-100%）与观察(45.8%，CI：36.8%-57.2%，22%,CI：13.2%-36.7%；p<0.001）。5年和9年的SHP率相当(SRS60.4%，CI：49.9%-73%，vs.观察51.4%，CI：41.3%-63.9%，和SRS27%，CI：14.5%-50.5%，vs.观察30%,CI：17.2%-52.2%；p=0.53）。SRS与较低的耳鸣几率相关(OR=0.39,p=0.01),前庭功能障碍（OR=0.11，p=0.004），和任何颅神经麻痹（OR=0.36，p=0.003），颅神经V或VII无变化（p>0.05）。与单独观察相比，肿瘤进展和/或任何先前结果的复合终点显示出与SRS相关的显著较低的几率(p<0.001)。
结论：在KoosI级和II级VS患者的配对队列中，SRS管理显示出更好的肿瘤控制，相当的听力保持率，并且出现神经功能缺损的几率大大降低。这些发现描述了SRS在该患者人群管理中的安全性和有效性。
