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Hearing preservation in patients with unilateral vestibular schwannoma who undergo stereotactic radiosurgery
Reinterpretation of the auditory brainstem response
Article first published online: 8 MAY 2012
Copyright © 2012 American Cancer Society
Volume 118, Issue 21, pages 5441–5447, 1 November 2012
How to Cite
Han, J. H., Kim, D. G., Chung, H.-T., Paek, S. H., Park, C.-K., Kim, C.-Y., Kim, Y.-H., Kim, J. W., Kim, Y. H., Song, S. W., Kim, I. K. and Jung, H.-W. (2012), Hearing preservation in patients with unilateral vestibular schwannoma who undergo stereotactic radiosurgery. Cancer, 118: 5441–5447. doi: 10.1002/cncr.27501
- Issue published online: 19 OCT 2012
- Article first published online: 8 MAY 2012
- Manuscript Accepted: 30 JAN 2012
- Manuscript Revised: 29 JAN 2012
- Manuscript Received: 3 JAN 2012
- vestibular schwannoma;
- hearing preservation;
- classification system;
- auditory brainstem response
The objective of this study was to identify the prognostic factors for hearing preservation that would allow the more accurate stratification of patients who undergo stereotactic radiosurgery (SRS) for unilateral, sporadic vestibular schwannoma (VS).
In total, 119 patients with VS who had serviceable hearing underwent SRS as primary treatment. The mean (±standard deviation) patient age was 48 ± 11 years, and the mean (±standard deviation) follow-up duration was 55.2 ± 35.7 months. The median marginal radiotherapy dose was 12.0 grays (Gy), and the mean (±standard deviation) tumor volume was 1.95 ± 2.24 cm3. The mean (±standard deviation) pure tone average (PTA) score was 26 ± 12 decibels (dB) (range, 4-50 dB), and the mean (±standard deviation) maximum speech discrimination score was 91 ± 12% (range, 52-100%). The mean (±standard deviation) baseline values for the interlatency (IL) of waves I and III (IL I-III) and the IL of waves I through V (IL I-V) on auditory brainstem response were 2.58 ± 0.60 milliseconds (mS) (range, 1.92-4.30 mS) and 4.80 ± 0.61 mS (range, 3.80-6.40 mS), respectively.
In multivariate analysis, the PTA score and IL I-V were significant and independent prognostic factors (hazard ratio, 1.072; 95% confidence interval, 1.046-1.098; P < .001; and hazard ratio, 1.534; 95% confidence interval, 1.008-2.336; P = .046, respectively). By using the PTA score and IL I-V, the patients were classified into 4 groups. The ratios of patients with serviceable hearing after SRS were 89.6%, 64.0%, 25.8%, and 6.7%, respectively, in Groups A through D (P < .001).
The current results indicated that the classification system based on using the PTA score and the IL I-V of the auditory brainstem response may be useful and specific for predicting the rate of hearing preservation in each individual. Cancer 2012. © 2012 American Cancer Society.