Associations With Changes in Disease-Specific Quality of Life Following Stereotactic Radiosurgery for Sporadic Vestibular Schwannoma.

in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery by Eric E Babajanian, Ghazal S Daher, James R Dornhoffer, Karl R Khandalavala, John P Marinelli, Christine M Lohse, Michael J Link, Matthew L Carlson

TLDR

  • The study investigated the association between SRS and QOL outcomes in 79 patients with VS and found that tumor extent and treated volume at SRS were statistically significantly associated with changes in QOL outcomes.
  • The study suggests that while SRS may have a statistically significant impact on QOL outcomes, it is unlikely to exceed clinically significant thresholds.

Abstract

To examine associations with changes in quality-of-life (QOL) outcomes following treatment of vestibular schwannoma (VS) using stereotactic radiosurgery (SRS). Prospective longitudinal study. Tertiary academic center. Patients who were treated for sporadic VS using SRS from 2015 to 2022 were included. QOL outcomes were measured using the disease-specific Penn Acoustic Neuroma QOL (PANQOL) scale. Seventy-nine patients with pre-SRS and at least one post-SRS PANQOL assessments were available for analysis. The mean change in total PANQOL scores was -2 (SD 13) on a 100-point scale. The mean duration between assessments was 4.6 years (SD 2.0). Age at SRS, sex, and SRS treatment doses were not significantly associated with changes in total PANQOL scores. Total PANQOL scores improved a mean of 4 points for patients with tumors confined to the internal auditory canal but declined a mean of 5 points for patients with tumors extending into the cerebellopontine angle (P = .01); however, these changes did not exceed the minimum clinically significant threshold of 11 points. The correlation coefficient between treated tumor volume at SRS and change in total PANQOL scores was -0.30 (P = .007). Changes in PANQOL total (P = .5) and hearing domain (P = .3) scores for patients who maintained serviceable hearing or progressed to nonserviceable hearing did not significantly differ. Tumor extent and treated volume at SRS had a statistically significant but likely not clinically important impact on total PANQOL scores. Progression to nonserviceable hearing did not have a significant impact on PANQOL total or hearing domain scores.

Overview

  • The study aimed to investigate the association between stereotactic radiosurgery (SRS) and quality-of-life (QOL) outcomes in patients with vestibular schwannoma (VS).
  • The study included 79 patients with pre-SRS and at least one post-SRS Penn Acoustic Neuroma QOL (PANQOL) assessments, treated from 2015 to 2022 at a tertiary academic center.
  • The primary objective was to examine the changes in QOL outcomes and identify predictors of improvement or decline in patients treated with SRS.

Comparative Analysis & Findings

  • The analysis found significant associations between tumor extent and treated volume at SRS with changes in total PANQOL scores, with a negative correlation between treated volume and total PANQOL scores (r = -0.30, p = 0.007).
  • Patients with tumors confined to the internal auditory canal showed improved total PANQOL scores (mean change = 4 points), while those with tumors extending into the cerebellopontine angle showed declined total PANQOL scores (mean change = -5 points) (p = 0.01).
  • Changes in PANQOL total and hearing domain scores did not significantly differ between patients who maintained serviceable hearing or progressed to nonserviceable hearing.

Implications and Future Directions

  • The study suggests that tumor extent and treated volume at SRS may have a statistically significant but likely not clinically important impact on QOL outcomes.
  • Future studies should investigate the effects of SRS on QOL outcomes in larger patient cohorts and explore potential predictors of improvement or decline in individual patients.
  • The study's findings may inform treatment decisions and counseling for patients with VS undergoing SRS, highlighting the importance of individualized patient assessment and management.
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