Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls

Abstract

abbreviatioNs AAO-HNS = American Academy of Otolaryngology-Head and Neck Surgery; CPA = cerebellopontine angle; GBI = Glasgow Benefit Inventory; HRQOL = health-related quality of life; IQR = interquartile range; MCID = minimum clinically important difference; PANQOL = Penn Acoustic Neuroma Quality-of-Life; PROMIS-10 = 10-item Patient-Reported Outcomes Measurement Information System; SF-36 = 36-Item Short Form Health Survey; SRS = stereotactic radiosurgery; VS = vestibular schwannoma. submitted March 18, 2014. accepted November 11, 2014. iNclude wheN citiNg Published online January 2, 2015; DOI: 10.3171/2014.11.JNS14594. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Internal departmental funding was used without commercial sponsorship or support. obJect The optimal treatment for sporadic vestibular schwannoma (VS) is highly controversial. To date, the majority of studies comparing treatment modalities have focused on a narrow scope of technical outcomes including facial function, hearing status, and tumor control. Very few publications have investigated health-related quality of life (HRQOL) differences between individual treatment groups, and none have used a disease-specific HRQOL instrument. methods All patients with sporadic small- to medium-sized VSs who underwent primary microsurgery, stereotactic radiosurgery (SRS), or observation between 1998 and 2008 were identified. Subjects were surveyed via postal questionnaire using the 36-Item Short Form Health Survey (SF-36), the 10-item Patient-Reported Outcomes Measurement Information System short form (PROMIS-10), the Glasgow Benefit Inventory (GBI), and the Penn Acoustic Neuroma Quality-of-Life (PANQOL) scale. Additionally, a pool of general population adults was surveyed, providing a nontumor control group for comparison. results A total of 642 respondents were analyzed. The overall response rate for patients with VS was 79%, and the mean time interval between treatment and survey was 7.7 years. Using multivariate regression, there were no statistically significant differences between management groups with respect to the PROMIS-10 physical or mental health dimensions, the SF-36 Physical or Mental Component Summary scores, or the PANQOL general, anxiety, hearing, or energy subdomains. Patients who underwent SRS or observation reported a better total PANQOL score and higher PANQOL facial, balance, and pain subdomain scores than the microsurgical cohort (p < 0.02). The differences in scores between the nontumor control group and patients with VS were greater than differences observed between individual treatment groups for the majority of measures. coNclusioNs The differences in HRQOL outcomes following SRS, observation, and microsurgery for VS are small. Notably, the diagnosis of VS rather than treatment strategy most significantly impacts quality of life. Understanding that a large number of VSs do not grow following discovery, and that intervention does not...

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

“…5 Using the same measure, Robinett et al reported a similar finding at 0-5 years of follow up; however, no statistically significant difference in pain was iden- (29) 19 (15) 56 (43) 17 (13) 116 (29) 93 (23) 155 (38) 39 (10) 1.0 (reference) 0.62 (0. tified between groups after 5 years. 34 Other studies have similarly demonstrated that differences in pain are greatest early after treatment; however, this disparity significantly declines within several years.…”

“…5 We found that the greatest reduction of HRQOL resulted from the disease itself, while long-term differences between treatment modalities were generally small. Only 3 of the 7 PANQOL domains demonstrated a statistically significant difference during global comparison: facial function, balance, and pain, with the latter exhibiting the largest difference between treatment arms.…”

Radiotherapy for vestibular schwannoma: Review of recent literature results

“…5 A recent long-term study confirmed the usefulness of the initial wait and see policy in the small VS and a better quality of life in the patients treated by SRS rather than microsurgery. 6 In this regard, it should be pointed out that radiation can affect neurologic function even after many years while surgery determines immediate neurological deficit. The length of follow-up in the various studies can therefore influence the incidence of neurologic impairment also on hearing function after radiation treatment.…”

“…However, a recent metanalysis reported a better hearing function (70.2% vs. 50.3%, p < 0.001) and a similar tumour control rate (96.2% vs. 98.7%, p = 0.122) comparing stereotactic radiation with microsurgery for treating small (<3 cm) VS. 2 Similar data come from recent reviews. 5,6 The very first reports on SRS for VS used quite high dose schedules, ranging from 10 up to 25 Gy delivered in single fraction. Local control with this approach was high (90-100%) but a significant number of adverse effects were observed, first of all hearing loss.…”

Predictive factors of acoustic neuroma growth

“…4 Hence, Carlson et al reported that hearing outcome in long term follow up was as poor as 23%. 34 10 years after stereotactic radiosurgery. They also confirmed initial hearing levels and tumor size as prognostic factors.…”