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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Long term results of acoustic neurinoma treated with LINAC and Cyberknife based stereotactic radiosurgery: a follow up of 335 patients

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  • Daniel Ruess - Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
  • Lea Pöhlmann - Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
  • Stefan Grau - Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
  • Harald Treuer - Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
  • Martin Kocher - Uniklinik Köln, Strahlenklinik, Köln, Deutschland
  • Maximilian I. Ruge - Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Uniklinik Köln, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.13.04

doi: 10.3205/17dgnc250, urn:nbn:de:0183-17dgnc2507

Published: June 9, 2017

© 2017 Ruess et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Tumor control and functional hearing preservation are the main goals to be reached in the treatment of acoustic neuroma (AN). Stereotactic radiosurgery (SRS) has evolved as alternative first-line treatment for AN. Here, we report the clinical and radiological long term follow-up of patients with AN treated with LINAC or Cyberknife® based SRS.

Methods: In this single center retrospective analysis we consecutively included all patients with AN who underwent single fraction LINAC or Cyberknife® based radiosurgery between 1991 and 2015 with a minimum follow-up of 2 months. Patient data were analyzed in terms of tumor control (defined as no further intervention required), preservation of functional hearing and incidence of early and late treatment related complications (rated by using the Common Terminology Criteria for Adverse Events, CTCAE; v4.03).

Results: 335 patients (f:m = 176:159, median age = 58 years) were treated either with LINAC (n=270) or Cyberknife® (n=65) -based SRS. Median tumor volume was 1.1ml ± 2.6ml (0.1-23.7). The median radiation dose was 12 Gy (range 11-20) at a median isodose level of 72 % (31.9-86.21). Median follow-up was 30 months (2-224 months). According to the Koos classification we identified 53 (15.8%) Koos I, 180 (53.7%) Koos II, 42 (12.5%) Koos III and 60 (17.9%) Koos IV tumors. 70 patients had surgery prior to SRS. The 2-, 5- and 10-year tumor control rate was 99%, 89% and 88%, respectively. Treatment failure was observed in 6.3% (n=21). Re-treatment included re-radiation in 2.7% and microsurgery in 3.6%. The Kaplan-Meier estimated an objective hearing preservation rate of 89% after 12 months, 80% after 24 months and 57% after 50 months. De novo permanent adverse events (CTCAE grade I and II) were objectively observed in 8,9% (n=30) cases.

Conclusion: SRS for AN leads to very good long term tumor control with a considerable rate of hearing preservation and a low rate of permanent side effects. SRS can be proposed as save and effective first line treatment alternative to - or in combination with - microsurgical resection.