TY - JOUR
T1 - Fractionated Proton Beam Therapy for Acoustic Neuromas: Tumor Control and Hearing Preservation
AU - Barnes, Carolyn J.
AU - Bush, David A.
AU - Grove, Roger I.
AU - Loredo, Lilia N.
AU - Slater, Jerry D.
N1 - Keywords: acoustic neuroma, proton therapy, tumor control, hearing preservation Acoustic neuromas (or vestibular schwannomas) are benign tumors that arise from the Schwann cells lining the VIIIth cranial nerve at the internal auditory meatus. Patients often present with unilateral sensorineural hearing loss, associated vertigo, and/or tinnitus, or the tumors may be found incidentally on imaging examinations.
PY - 2018/7/26
Y1 - 2018/7/26
N2 - Purpose: This prospective cohort evaluated patients with acoustic neuroma treated with proton irradiation at Loma Linda University Medical Center. A dose of 50.4 Gy in 28 fractions was given to improve hearing preservation while maintaining tumor control. Patients and Methods: Ninety-five patients were treated from March 1991 to March 2008. Fractionated proton radiotherapy at daily doses of 1.8 Gy was employed. Patients were treated to 1 of 3 total doses: 59.4 Gy, used initially for patients without serviceable hearing; 54 Gy, used for patients with serviceable hearing through October 2000; and 50.4 Gy used since 2001 for patients with serviceable hearing. Survival and local control were calculated using the Kaplan-Meier method. Logistic regression analysis was preformed comparing dose, tumor size, and tumor location with hearing preservation. Results: Ninety-four patients were assessable; the median follow-up was 64 months. Five-year local control rates for the 59.4 Gy, 54 Gy, and 50.4 Gy groups were 95%, 97%, and 92%, respectively ( P = .80); the overall 10-year actuarial control rate was 90%. Cranial nerve injuries occurred in <5% in all groups. Four-year actuarial rates of hearing preservation were maintained in 44% of patients treated with 54 Gy and 64% treated with 50.4 Gy ( P = .284). On multivariate analysis, initial tumor diameter (≤1.5 cm) was found to be a prognostic factor for maintaining serviceable hearing in both groups ( P = .011). Conclusions: Fractionated proton therapy of 50.4 Gy offers excellent local control and minimal cranial nerve toxicities. Improved rates of hearing preservation that are comparable with radiosurgery were seen with 50.4 Gy compared with higher doses, although this did not reach significance. Maintaining hearing was found to be associated with smaller initial tumor size
AB - Purpose: This prospective cohort evaluated patients with acoustic neuroma treated with proton irradiation at Loma Linda University Medical Center. A dose of 50.4 Gy in 28 fractions was given to improve hearing preservation while maintaining tumor control. Patients and Methods: Ninety-five patients were treated from March 1991 to March 2008. Fractionated proton radiotherapy at daily doses of 1.8 Gy was employed. Patients were treated to 1 of 3 total doses: 59.4 Gy, used initially for patients without serviceable hearing; 54 Gy, used for patients with serviceable hearing through October 2000; and 50.4 Gy used since 2001 for patients with serviceable hearing. Survival and local control were calculated using the Kaplan-Meier method. Logistic regression analysis was preformed comparing dose, tumor size, and tumor location with hearing preservation. Results: Ninety-four patients were assessable; the median follow-up was 64 months. Five-year local control rates for the 59.4 Gy, 54 Gy, and 50.4 Gy groups were 95%, 97%, and 92%, respectively ( P = .80); the overall 10-year actuarial control rate was 90%. Cranial nerve injuries occurred in <5% in all groups. Four-year actuarial rates of hearing preservation were maintained in 44% of patients treated with 54 Gy and 64% treated with 50.4 Gy ( P = .284). On multivariate analysis, initial tumor diameter (≤1.5 cm) was found to be a prognostic factor for maintaining serviceable hearing in both groups ( P = .011). Conclusions: Fractionated proton therapy of 50.4 Gy offers excellent local control and minimal cranial nerve toxicities. Improved rates of hearing preservation that are comparable with radiosurgery were seen with 50.4 Gy compared with higher doses, although this did not reach significance. Maintaining hearing was found to be associated with smaller initial tumor size
KW - acoustic neuroma
KW - proton therapy
KW - tumor control
KW - hearing preservation
UR - https://europepmc.org/article/PMC/PMC6871573
UR - http://dx.doi.org/10.14338/ijpt-14-00014.1
U2 - 10.14338/IJPT-14-00014.1
DO - 10.14338/IJPT-14-00014.1
M3 - Article
VL - 4
JO - International Journal of Particle Therapy
JF - International Journal of Particle Therapy
ER -