目的:立体定向放射外科(SRS)是一种完善的前庭神经鞘瘤(VS)治疗方法。听力损失仍然是VS及其治疗的主要发病率,包括SRS。SRS的辐射参数对听力的影响仍然未知。这项研究的目的是确定肿瘤体积的影响,患者人口统计学,预处理听力状态,耳蜗辐射剂量,肿瘤总辐射剂量,分馏,和其他放射治疗参数对听力恶化。
方法:多中心回顾性分析了1990-2020年因VS接受SRS治疗并有治疗前后听力图的611例患者。
结果:在12-60个月时,治疗后耳朵的纯音平均值(PTAs)增加,单词识别得分(WRS)降低,而未治疗的耳朵保持稳定。较高的基线PTA,更高的肿瘤辐射剂量,较高的最大耳蜗剂量,单部分的使用导致较高的辐射后PTA;WRS仅由基线WRS和年龄预测。较高的基线PTA,单级处理,更高的肿瘤辐射剂量,较高的最大耳蜗剂量导致PTA的更快恶化。在3Gy的最大耳蜗剂量以下,PTA或WRS无统计学显著变化.
结论:SRS后VS患者一年听力下降与最大耳蜗剂量直接相关,单次治疗与3分治疗相比,肿瘤总辐射剂量,和基线听力水平。一年内保存心脏克罗布的最大安全耳蜗剂量为3Gy,使用3个分数代替一个分数在保持听力方面更好。
Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration.
Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990-2020 and had pre- and post-treatment audiograms.
Pure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12-60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS.
Decline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.