Decrease in cranial nerve complications after radiosurgery for acoustic neuromas

A prospective study of dose and volume

Robert C. Miller, Robert L. Foote, Robert J. Coffey, Daniel J. Sargent, Deborah A. Gorman, Paula J. Schomberg, Robert W. Kline

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Purpose: To determine whether tumor control can be maintained, and cranial nerve complications decreased by reducing the radiosurgical dose to acoustic neuromas. Methods and Materials: Forty-two consecutive patients with acoustic neuromas were treated prospectively using an initial standard-dose protocol in which the tumor-margin dose (50% isodose) was 20, 18, and 16 Gy for tumor diameters ≤ 2 cm, 2.1-3 cm, and 3.1-4 cm, respectively. After analysis of tumor control and complications, the next 40 patients were treated using a reduced-dose protocol in which the tumor-margin dose was 16, 14, and 12 Gy for tumor volumes ≤ 4.2 cm3, 4.2-14.1 cm3, and ≥ 14.1 cm3, respectively. Results: Median follow-up was 2.3 years (range 0.1-6) for 80 of 82 patients. The actuarial incidence (Kaplan-Meier of facial neuropathy at 2 years was 38% (95% confidence interval [CI], 23-53%) for the standard-dose protocol and 8% (95% CI, 0-17%) for the reduced-dose protocol (p = 0.006). Univariate analysis revealed an association between risk of facial neuropathy and use of CT planning, higher radiosurgical dose, and neurofibromatosis, type 2. Multivariate analysis revealed that the only factor associated with increased risk of post-treatment facial neuropathy was a tumor margin dose ≥ 18 Gy. The incidence of trigeminal neuropathy at 2 years was 29% (95% CI, 15- 43%) for the standard-dose protocol and 15% (95% CI, 3-27%) for the reduced- dose protocol (p = 0.17). Univariate analysis revealed an association between maximal tumor diameter and increased risk of neuropathy; multivariate analysis revealed no additional statistically significant trigeminal associations between tumor and dosimetric and patient characteristics and risk of trigeminal neuropathy. Two tumors in the standard-dose protocol required salvage surgery for progression. To date, no tumor in the reduced- dose protocol has shown progression. Conclusion: Our analysis suggests that a tumor margin dose of ≥ 18 Gy is the most significant risk factor for facial nerve complications after acoustic neuroma radiosurgery. Patients receiving a minimal tumor dose of ≤ 16 Gy are at significantly lower risk for permanent facial neuropathy after radiosurgery. Longer follow-up is required before definitive conclusions can be made about the ultimate rate of tumor control using reduced radiosurgical doses.

Original languageEnglish (US)
Pages (from-to)305-311
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume43
Issue number2
DOIs
StatePublished - Jan 15 1999

Fingerprint

Acoustic Neuroma
Radiosurgery
Cranial Nerves
nerves
Prospective Studies
tumors
dosage
acoustics
Facial Nerve Diseases
Neoplasms
Trigeminal Nerve Diseases
Confidence Intervals
confidence
margins
intervals
Multivariate Analysis
progressions
Neurofibromatosis 2
incidence
Incidence

Keywords

  • Acoustic neuroma
  • Complications
  • Cranial nerve
  • Gamma knife
  • Neuropathy
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Decrease in cranial nerve complications after radiosurgery for acoustic neuromas : A prospective study of dose and volume. / Miller, Robert C.; Foote, Robert L.; Coffey, Robert J.; Sargent, Daniel J.; Gorman, Deborah A.; Schomberg, Paula J.; Kline, Robert W.

In: International Journal of Radiation Oncology Biology Physics, Vol. 43, No. 2, 15.01.1999, p. 305-311.

Research output: Contribution to journalArticle

Miller, Robert C. ; Foote, Robert L. ; Coffey, Robert J. ; Sargent, Daniel J. ; Gorman, Deborah A. ; Schomberg, Paula J. ; Kline, Robert W. / Decrease in cranial nerve complications after radiosurgery for acoustic neuromas : A prospective study of dose and volume. In: International Journal of Radiation Oncology Biology Physics. 1999 ; Vol. 43, No. 2. pp. 305-311.
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abstract = "Purpose: To determine whether tumor control can be maintained, and cranial nerve complications decreased by reducing the radiosurgical dose to acoustic neuromas. Methods and Materials: Forty-two consecutive patients with acoustic neuromas were treated prospectively using an initial standard-dose protocol in which the tumor-margin dose (50{\%} isodose) was 20, 18, and 16 Gy for tumor diameters ≤ 2 cm, 2.1-3 cm, and 3.1-4 cm, respectively. After analysis of tumor control and complications, the next 40 patients were treated using a reduced-dose protocol in which the tumor-margin dose was 16, 14, and 12 Gy for tumor volumes ≤ 4.2 cm3, 4.2-14.1 cm3, and ≥ 14.1 cm3, respectively. Results: Median follow-up was 2.3 years (range 0.1-6) for 80 of 82 patients. The actuarial incidence (Kaplan-Meier of facial neuropathy at 2 years was 38{\%} (95{\%} confidence interval [CI], 23-53{\%}) for the standard-dose protocol and 8{\%} (95{\%} CI, 0-17{\%}) for the reduced-dose protocol (p = 0.006). Univariate analysis revealed an association between risk of facial neuropathy and use of CT planning, higher radiosurgical dose, and neurofibromatosis, type 2. Multivariate analysis revealed that the only factor associated with increased risk of post-treatment facial neuropathy was a tumor margin dose ≥ 18 Gy. The incidence of trigeminal neuropathy at 2 years was 29{\%} (95{\%} CI, 15- 43{\%}) for the standard-dose protocol and 15{\%} (95{\%} CI, 3-27{\%}) for the reduced- dose protocol (p = 0.17). Univariate analysis revealed an association between maximal tumor diameter and increased risk of neuropathy; multivariate analysis revealed no additional statistically significant trigeminal associations between tumor and dosimetric and patient characteristics and risk of trigeminal neuropathy. Two tumors in the standard-dose protocol required salvage surgery for progression. To date, no tumor in the reduced- dose protocol has shown progression. Conclusion: Our analysis suggests that a tumor margin dose of ≥ 18 Gy is the most significant risk factor for facial nerve complications after acoustic neuroma radiosurgery. Patients receiving a minimal tumor dose of ≤ 16 Gy are at significantly lower risk for permanent facial neuropathy after radiosurgery. Longer follow-up is required before definitive conclusions can be made about the ultimate rate of tumor control using reduced radiosurgical doses.",
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AU - Sargent, Daniel J.

AU - Gorman, Deborah A.

AU - Schomberg, Paula J.

AU - Kline, Robert W.

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N2 - Purpose: To determine whether tumor control can be maintained, and cranial nerve complications decreased by reducing the radiosurgical dose to acoustic neuromas. Methods and Materials: Forty-two consecutive patients with acoustic neuromas were treated prospectively using an initial standard-dose protocol in which the tumor-margin dose (50% isodose) was 20, 18, and 16 Gy for tumor diameters ≤ 2 cm, 2.1-3 cm, and 3.1-4 cm, respectively. After analysis of tumor control and complications, the next 40 patients were treated using a reduced-dose protocol in which the tumor-margin dose was 16, 14, and 12 Gy for tumor volumes ≤ 4.2 cm3, 4.2-14.1 cm3, and ≥ 14.1 cm3, respectively. Results: Median follow-up was 2.3 years (range 0.1-6) for 80 of 82 patients. The actuarial incidence (Kaplan-Meier of facial neuropathy at 2 years was 38% (95% confidence interval [CI], 23-53%) for the standard-dose protocol and 8% (95% CI, 0-17%) for the reduced-dose protocol (p = 0.006). Univariate analysis revealed an association between risk of facial neuropathy and use of CT planning, higher radiosurgical dose, and neurofibromatosis, type 2. Multivariate analysis revealed that the only factor associated with increased risk of post-treatment facial neuropathy was a tumor margin dose ≥ 18 Gy. The incidence of trigeminal neuropathy at 2 years was 29% (95% CI, 15- 43%) for the standard-dose protocol and 15% (95% CI, 3-27%) for the reduced- dose protocol (p = 0.17). Univariate analysis revealed an association between maximal tumor diameter and increased risk of neuropathy; multivariate analysis revealed no additional statistically significant trigeminal associations between tumor and dosimetric and patient characteristics and risk of trigeminal neuropathy. Two tumors in the standard-dose protocol required salvage surgery for progression. To date, no tumor in the reduced- dose protocol has shown progression. Conclusion: Our analysis suggests that a tumor margin dose of ≥ 18 Gy is the most significant risk factor for facial nerve complications after acoustic neuroma radiosurgery. Patients receiving a minimal tumor dose of ≤ 16 Gy are at significantly lower risk for permanent facial neuropathy after radiosurgery. Longer follow-up is required before definitive conclusions can be made about the ultimate rate of tumor control using reduced radiosurgical doses.

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KW - Complications

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KW - Gamma knife

KW - Neuropathy

KW - Stereotactic radiosurgery

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