CyberKnife Stereotactic Radiosurgery for Growing Vestibular Schwannoma: Longitudinal Tumor Control, Hearing Outcomes, and Predicting Post‐Treatment Hearing Status

Abstract

Objectives(1) To determine tumor control rates for treating growing vestibular schwannoma (VS) with CyberKnife stereotactic radiosurgery (CK SRS); (2) to determine hearing outcomes after CK SRS; (3) to propose a set of variables that could be used to predict hearing outcomes for patients receiving CK SRS for VS.Study DesignRetrospective case series review.Methods127 patients who received CK SRS for radiographically documented growing VS were reviewed. Tumors were monitored for post‐procedure growth radiographically with linear measurements and three‐dimensional segmental volumetric analysis (3D‐SVA). Hearing outcomes were reviewed for 109 patients. Cox proportional hazard modeling was used to identify variables correlated with hearing outcomes.ResultsTumor control rate was 94.5% for treating VS with CK SRS. Hearing outcomes were categorized using the American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) classification system. As of their last available audiogram, 33.3% of patients with pre‐treatment class A and 26.9% of patients with class B retained their hearing in that class. 15.3% of patients starting with class A or B with extended follow‐up (>60 months), maintained hearing within this same grouping. Our final model proposed to predict hearing outcomes included age, fundal cap distance (FCD), tumor volume, and maximum radiation dose to the cochlea; however, FCD was the only statistically significant variable.ConclusionCK SRS is an effective treatment for control of VS. Hearing preservation by class was achieved in a third of patients. Finally, FCD was found to be protective against hearing loss.Level of Evidence4 Laryngoscope, 134:S1–S12, 2024