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Nicol C, Pinkham MB, Foote M, McBean A, Conlon E, Ownsworth T. Patient reported outcomes and short-term adjustment trajectories following gamma knife radiosurgery for benign brain tumor. Disabil Rehabil 2024:1-10. [PMID: 39263895 DOI: 10.1080/09638288.2024.2401631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 08/25/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE Patient reported outcomes (PROs) in the context of Gamma Knife Stereotactic Radiosurgery (GKSRS) for benign brain tumor have been under-researched. This study examined changes in PROs and adjustment trajectories post-GKSRS. METHOD 50 adults (54% female) aged on average 53.18 (SD = 14.76) years with benign brain tumor were assessed 1 week before GKSRS, 1-2 weeks post-GKSRS, and at 3-month follow-up. Telephone-based questionnaires of anxiety and depressive symptoms, cognitive function, symptom burden, and health-related quality of life (HRQoL) were completed. RESULTS Significant improvements in HRQoL, perceived cognitive ability, anxiety, and total brain tumor symptoms were evident between pre-GKSRS and 3-month follow-up. Conversely, there was a significant short-term increase in depressive symptoms at post-GKSRS; however, levels did not differ from pre-GKSRS at follow-up. No significant changes were evident on PROs of headaches or fatigue. About half of the participants (46-51%) experienced reliable improvement in global HRQoL, and one-third (31-34%) reported improved anxiety symptoms. Increased depressive symptoms was seen in 34% of participants post-GKSRS and 18% at follow-up. CONCLUSIONS At 3 months post-GKSRS, improvements in HRQoL, anxiety, perceived cognitive ability, and total brain tumor symptoms were evident. Routine monitoring and support for pre-GKSRS anxiety and depressive symptoms post-GKSRS is recommended.
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Affiliation(s)
- Chelsea Nicol
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt, Australia
| | - Mark B Pinkham
- School of Medicine, University of Queensland, Brisbane, Australia
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Matthew Foote
- School of Medicine, University of Queensland, Brisbane, Australia
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Angela McBean
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Elizabeth Conlon
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Mount Gravatt, Australia
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Campbell T, Goh SJ, Wadeson AM, Freeman SR, Rutherford SA, King AT, Hammerbeck-Ward CL, Pathmanaban O, Entwistle H, Bird J, Axon PR, Moffat DA, Lloyd SK. Changes in audiovestibular handicap following treatment of vestibular schwannomas. J Laryngol Otol 2024; 138:608-614. [PMID: 38017610 PMCID: PMC11096832 DOI: 10.1017/s002221512300213x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/23/2023] [Accepted: 10/02/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE This study aimed to assess degree of audiovestibular handicap in patients with vestibular schwannoma. METHODS Audiovestibular handicap was assessed using the Hearing Handicap Inventory, Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Patients completed questionnaires at presentation and at least one year following treatment with microsurgery, stereotactic radiosurgery or observation. Changes in audiovestibular handicap and factors affecting audiovestibular handicap were assessed. RESULTS All handicap scores increased at follow up, but not significantly. The Tinnitus Handicap Inventory and Dizziness Handicap Inventory scores predicted tinnitus and dizziness respectively. The Hearing Handicap Inventory was not predictive of hearing loss. Age predicted Tinnitus Handicap Inventory score and microsurgery was associated with a deterioration in Dizziness Handicap Inventory score. CONCLUSION Audiovestibular handicap is common in patients with vestibular schwannoma, with 75 per cent having some degree of handicap in at least one inventory. The overall burden of handicap was, however, low. The increased audiovestibular handicap over time was not statistically significant, irrespective of treatment modality.
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Affiliation(s)
- Tim Campbell
- Brighton and Sussex Medical School, Brighton, UK
| | | | - Andrea M Wadeson
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Simon R Freeman
- Department of Otolaryngology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew T King
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Brain and Mental Health, University of Manchester, Manchester, UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Brain and Mental Health, University of Manchester, Manchester, UK
| | - Charlotte L Hammerbeck-Ward
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Omar Pathmanaban
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Helen Entwistle
- Department of Neurosurgery, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Judith Bird
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
| | - Patrick R Axon
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
| | - David A Moffat
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
| | - Simon K Lloyd
- Department of Otolaryngology, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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Pisani D, Gioacchini FM, Chiarella G, Astorina A, Ricciardiello F, Scarpa A, Re M, Viola P. Vestibular Impairment in Patients with Vestibular Schwannoma: A Journey through the Pitfalls of Current Literature. Audiol Res 2023; 13:285-303. [PMID: 37102775 PMCID: PMC10135541 DOI: 10.3390/audiolres13020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
Vestibular Schwannoma is the most common tumour of Ponto Cerebellar Angle and is capable of strongly impacting the patient's quality of life. In recent decades, the proposals for the management of the disease have multiplied, just as the diagnostic capacity has improved. While in the past, the primary objective was the preservation of the facial function, and subsequently also of the auditory function, the attention to the vestibular symptomatology, which appears to be one of the main indicators of deterioration of quality of life, is still unsatisfactory. Many authors have tried to provide guidance on the best possible management strategy, but a universally recognized guideline is still lacking. This article offers an overview of the disease and the proposals which have advanced in the last twenty years, evaluating their qualities and defects in a critical reading.
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Affiliation(s)
- Davide Pisani
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Federico Maria Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessia Astorina
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Pasquale Viola
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
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Neve OM, Jansen JC, Koot RW, Ridder MD, Paul G van Benthem P, Stiggelbout AM, Hensen EF. Long-Term Quality of Life of Vestibular Schwannoma Patients: A Longitudinal Analysis. Otolaryngol Head Neck Surg 2023; 168:210-217. [PMID: 35349360 DOI: 10.1177/01945998221088565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Vestibular schwannoma management aims to maintain optimal quality of life (QoL) while preventing severe sequelae of the tumor or its treatment. This study assessed long-term QoL of patients with vestibular schwannoma in relation to treatment modality and decisional regret. STUDY DESIGN A longitudinal study, in which clinical and QoL data were used that were cross-sectionally acquired in 2014 and again in 2020 from the same patient group. SETTING A tertiary expert center for vestibular schwannoma care in the Netherlands. METHODS QoL was measured by the Penn Acoustic Quality of Life (PANQOL) scale. Changes in time were assed using a linear mixed model. In addition, the Decision Regret Scale was analyzed. RESULTS Of 867 patients, 536 responded (62%), with a median follow-up of 11 years. All PANQOL subdomain scores remained stable over time and did not exceed minimal clinically important difference (MCID) levels. Time since treatment did not affect QoL. Patients had comparable average QoL scores and proportions of patients with changing QoL scores (ie, exceeding the MCID) over time, irrespective of the received initial treatment. Female patients and those who required salvage therapy (either by radiotherapy or surgery) reported a lower QoL. The latter patient group reported the highest decisional regret. CONCLUSION On average, the long-term QoL of patients with vestibular schwannoma is comparable for patients under active surveillance and those who have received active treatment, and it remains stable over time. This suggests that, on average, preservation of QoL of patients with vestibular schwannoma is feasible when adequately managed.
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Affiliation(s)
- Olaf M Neve
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Radboud W Koot
- Department of Neurosurgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Mischa de Ridder
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, South Holland, The Netherlands
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Adegboyega G, Jordan C, Kawka M, Chisvo N, Toescu SM, Hill C. Quality of life reporting in the management of posterior fossa tumours: A systematic review. Front Surg 2022; 9:970889. [PMID: 36303860 PMCID: PMC9594859 DOI: 10.3389/fsurg.2022.970889] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Survival amongst posterior fossa tumour (PFT) patients is improving. Clinical endpoints such as overall survival fail to depict QoL. There is yet to be a review of current QoL instruments used for adult PFTs. Aim of this review is to outline the QoL reporting in the management of PFTs and measure participation level. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A search strategy to identify adult patients with PFTs who took part in QoL metrics was conducted. Observational and experimental studies published from 1990 to date were included. Studies with a sample size less than 10 and performance measures such as Karnofsky Performance Status were not considered. Results A total of 116 studies were included in the final analysis. Vestibular schwannomas were the most common tumour pathology (n = 23,886, 92.6%) followed by pilocytic astrocytomas (n = 657, 2.5%) and meningiomas (n = 437, 1.7%) Twenty-five different QoL measures were used in the study pool. SF-36 was the most common (n = 55, 17 47.4%) QoL metric in the whole study pool, followed by the Penn Acoustic Neuroma QoL scale (n = 24, 20.7%) and Dizziness Handicap Inventory (n = 16, 13.8%). Seventy-two studies reported less-than 100% participation in QoL evaluation. The commonest reason for non-participation was a lack of response (n = 1,718, 60.8%), incomplete questionnaires (n = 268, 9.4%) and cognitive dysfunction (n = 258, 9.1%). Conclusion Informed clinical decision-making in PFT patients requires the development of specific QoL outcomes. Core outcome sets, and minimal clinically important differences (MCID) are essential for these metrics to show clinically significant improvements in patient QoL.
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Affiliation(s)
- Gideon Adegboyega
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Chloe Jordan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Michal Kawka
- Imperial College London School of Medicine, London, United Kingdom
| | - Nathan Chisvo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Ciaran Hill
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- University College London Cancer Institute, London, United Kingdom
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A Systematic Review of Interventions for Balance Dysfunction in Patients With Vestibular Schwannoma. Otol Neurotol 2021; 41:e295-e303. [PMID: 31834215 DOI: 10.1097/mao.0000000000002530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Dizziness is a major contributing factor to poor quality of life for patients with vestibular schwannoma (acoustic neuroma). We wished to review the literature on interventions for balance dysfunction in these patients. DATA SOURCES A systematic literature review was performed identifying studies that measured balance function before and after treatment for vestibular schwannoma. Data sources include Medline (1950-present), EMBASE (1974-present), Cochrane Library (issue 3, 2008), NHS Centre of reviews and dissemination, Clinical Evidence, Cochrane central register of controlled trial, and CINAHL. STUDY SELECTION A minimum follow-up of 6 months was required, to estimate long-term balance function. Eight articles were identified, including five studies with surgical intervention, two studies with stereotactic radiotherapy, and one comparing the two. Study design was generally poor with a high risk of bias. These studies all utilized the Dizziness Handicap Inventory (DHI) as a measure of pre- and postintervention balance function. DATA EXTRACTION Results showed that overall DHI scores are not statistically affected by intervention irrespective of modality (surgery or stereotactic radiotherapy). Patients selected with severe dizziness, who undergo surgery, improved postoperatively. No other studies for severe dizziness were noted for comparison. CONCLUSIONS Age, sex, and tumor size have no statistically significant effect on DHI outcomes, and no evidence to suggest which treatment modality has better dizziness related outcomes.No specific treatment modality was superior in terms of long-term balance function. Patients with severe dizziness may benefit from surgery, although no comparator studies were identified.
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Longitudinal Changes of Quality of Life and Hearing Following Radiosurgery for Vestibular Schwannoma. Cancers (Basel) 2021; 13:cancers13061315. [PMID: 33804061 PMCID: PMC7998632 DOI: 10.3390/cancers13061315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Since vestibular schwannomas are slow-growing tumors that can be controlled with different treatment modalities such as neurosurgery or radiotherapy, preserving quality of life is an important consideration. In this study, we analyzed how quality of life (QoL) changes for patients who receive stereotactic radiation in the months and years after treatment and if there is a correlation between changes in QoL and changes in hearing function. The results suggest that proper hearing of the unaffected ear might compensate for a hearing loss of the other ear due to the tumor or the treatment and in turn preserve QoL. However, this association should be confirmed in additional studies. Abstract Background: Most existing publications on quality of life (QoL) following stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) gather information retrospectively by conducting surveys several years after treatment. The purpose of this study is therefore to provide longitudinal QoL data and assess how changes in hearing impact QoL. Methods: Patients completed the 12-item short-form (SF-12) health survey prior to treatment and at every follow-up visit. One hundred and seventy-five patients who had complete forms prior to treatment as well as at an early and at a late follow-up were included in the analysis. For 51 of these patients, longitudinal audiometry data were available. Results: Median follow-up was 7.2 years. Patients experienced a significant reduction in the physical composite score (PCS, p = 0.011) compared to before treatment. The mental composite score (MCS) increased significantly (p = 0.032). A decrease in PCS was not significantly correlated with an increased hearing threshold on the affected but rather on the unaffected ear (r(49) = −0.32, p = 0.023). Conclusions: It is unclear whether the decline in the PCS is due to treatment-related toxicity or the normal decline of PCS with age. Ensuring proper hearing on the untreated ear might be crucial to ensure good QoL for patients treated with SRS for VS, though this association should be confirmed in additional studies.
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Self-Evaluated Quality of Life and Functional Outcomes After Microsurgery, Stereotactic Radiation or Observation-Only for Vestibular Schwannoma of the Adult Patient: A Systematic Review. Otol Neurotol 2019; 39:232-241. [PMID: 29315189 DOI: 10.1097/mao.0000000000001664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the impact of different management options on health-related quality of life (HRQoL) in vestibular schwannoma patients. DATA SOURCES A systematic search of the Cochrane Database, Database of Abstracts of Reviews of Effectiveness, and the Ovid Medline & EMBASE was performed. English and German language studies published between 1980 and 2015 were considered. STUDY SELECTION This is a systematic review of HRQoL of patients managed for vestibular schwannoma. Studies in which HRQoL after one management option were evaluated or compared with other managements or with control populations using validated or reliable questionnaires, were included. DATA EXTRACTION The included studies were independently evaluated by two reviewers. The quality of studies was assessed and graded as per Oxford Centre of Evidence Based Medicine System. RESULTS Ten prospective and 29 retrospective studies were identified: microsurgery initially exerted a negative effect on HRQoL but this tended to improve with follow up. Radiotherapy had a less negative effect but with minimal change over follow up. A significant limitation was that studies did not present results stratified by tumor size. Many patients will need active treatment despite the potential for negative effects on their QoL. The concept of a minimal clinically important difference has been introduced into this field and was compared with five studies. CONCLUSION A number of prospective studies are available but none yet with a disease-specific questionnaire. Heterogeneity and the methodological weaknesses of the included studies constitute the principle limitation of this review. The introduction of the minimal clinically important difference should improve the relevance of studies and allow a sensitive comparison of treatments.
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9
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Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas. Strahlenther Onkol 2019; 196:40-47. [DOI: 10.1007/s00066-019-01498-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
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Kim G, Hullar TE, Seo JH. Comparison of balance outcomes according to treatment modality of vestibular schwannoma. Laryngoscope 2019; 130:178-189. [PMID: 30693520 DOI: 10.1002/lary.27830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We sought to compare balance outcomes according to treatment modality of vestibular schwannoma (VS) via a meta-analysis that divided measuring tools of balance outcomes into three categories based on type. METHODS A comprehensive review of the literature from January 1966 to September 2017 was performed, looking for studies about long-term balance outcomes after microsurgery (MS), radiotherapy (RT), or observation for VS. A comprehensive meta-analysis was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and Egger's regression. RESULTS Among 633 references, 34 were included in the meta-analysis. Perceived dizziness improvement rate was significantly higher in the MS group than in the RT group (odds ratio [OR]: 1.61; 95% confidence interval [CI]: 1.08 to 2.40; P < .05, I2 = 4.18], but no significant difference was observed between the two groups with regard to validated dizziness questionnaire score (standardized mean difference: 0.04; 95% CI: -0.36 to 0.44; P = .84, I2 = 69.61) or dizziness or disequilibrium-related symptom incidence rate (OR: 0.91; 95% CI: 0.50 to 1.68; P = .77, I2 = 0). In a subanalysis conducted within the groups after intervention, the MS group demonstrated a lower vertigo incidence rate (P < .001), and the RT group experienced a significant reduction in validated dizziness questionnaire score (P < .05). CONCLUSIONS Our results indicate that MS should be considered at least equal to RT in regard to resolving long-term dizziness and improving balance outcomes. Furthermore, well-designed studies are necessary to predict balance outcomes after VS treatment and to choose from among possible treatment options. LEVEL OF EVIDENCE 2a Laryngoscope, 130:178-189, 2020.
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Affiliation(s)
- Gaeun Kim
- Research Institute for Nursing Science, Keimyung University, College of Nursing, Daegu, South Korea
| | - Timothy E Hullar
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Jae-Hyun Seo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Abstract
BACKGROUND Vestibular schwannoma (VS) is a disease which might affect health-related quality of life (HR-QOL) in a negative manner. For many years, only generic quality of life instruments such as SF-36 were available to measure HR-QOL. However, some years ago, the Penn Acoustic Neuroma Quality Of Life (PANQOL) tool, a disease-specific instrument, was developed and validated. It is expected that the application of this instrument will be able to better assess relevant aspects of the HR-QOL of VS patients in the future. A validated German version of the instrument does not exist yet. The disease-specific symptoms most frequently named by patients are headache and dizziness. RESULTS AND DISCUSSION The available literature shows that the therapeutic approaches affect HR-QOL differently. In particular, radiation therapy of small and medium-sized tumors has no pronounced negative effects on HR-QOL. However, restrictions after surgery become similar to those after radiotherapy over the course of several years. For large VS with a diameter >3 cm, no guiding data on this aspect are currently available. To clarify the outstanding issues, future prospective studies with long-term follow-up of 10 years and more are desirable.
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Affiliation(s)
- I Baumann
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - P K Plinkert
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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12
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Abstract
OBJECTIVE To examine the differences in quality of life for vestibular schwannoma patients undergoing conservative management, gamma knife, and surgery. PATIENTS Vestibular schwannoma patients without a diagnosis of NF2. INTERVENTIONS Vestibular schwannoma treatment or conservative management. MAIN OUTCOME MEASURES Penn Acoustic Neuroma Quality of Life (PANQOL) survey scores (0-100). RESULTS One hundred eighty-six patients (98 conservative, 49 gamma knife, 39 surgery) were included. Mean patient age (years) of the surgery group (49 ± 14) was significantly younger than both the conservative (58 ± 13) and gamma knife group (59 ± 12) (p < 0.001). Mean follow-up time was 2.6 years.Tumor size (mm) was found to be significantly different between the conservative (8 ± 4.8), gamma knife (18 ± 5.9), and surgery (22 ± 8.3) groups (p < 0.001). Speech recognition threshold and speech discrimination percentage were significantly better for the conservative group compared to the gamma knife or surgery groups (p < 0.001).The hearing domain scores seemed better for the conservative group (62 ± 26) when compared to the surgery group (47 ± 25). The general and total domain scores were similar for all treatment groups, whereas the quality-of-life scores for gamma knife and surgery were similar. CONCLUSION Although surgery groups' significantly larger tumors and worse hearing were apparent in specific PANQOL domains, all patients achieved a similar general level of quality of life.
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13
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van Leeuwen BM, Herruer JM, Putter H, van der Mey AGL, Kaptein AA. The art of perception: Patients drawing their vestibular schwannoma. Laryngoscope 2015; 125:2660-7. [DOI: 10.1002/lary.25386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Bibian M. van Leeuwen
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Jasmijn M. Herruer
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Hein Putter
- Department of Medical Statistics; Leiden University Medical Center; Leiden the Netherlands
| | - Andel G. L. van der Mey
- Department of Otorhinolaryngology-Head and Neck Surgery; Leiden University Medical Center; Leiden the Netherlands
| | - Adrian A. Kaptein
- Department of Medical Psychology; Leiden University Medical Center; Leiden the Netherlands
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Combs SE, Engelhard C, Kopp C, Wiedenmann N, Schramm O, Prokic V, Debus J, Molls M, Grosu AL. Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas – Pooled results from 3 large German centers. Radiother Oncol 2015; 114:378-83. [DOI: 10.1016/j.radonc.2015.01.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
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15
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Basura GJ, Budenz C, Arts HA. Vestibular Schwannomas: Surgical and Nonsurgical Management. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Robinett ZN, Walz PC, Miles-Markley B, Moberly AC, Welling DB. Comparison of Long-term Quality-of-Life Outcomes in Vestibular Schwannoma Patients. Otolaryngol Head Neck Surg 2014; 150:1024-32. [DOI: 10.1177/0194599814524531] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/29/2014] [Indexed: 11/17/2022]
Abstract
Objective To compare long-term quality-of-life outcomes in vestibular schwannoma patients managed with observation, microsurgery, or stereotactic radiation. Study Design ross-sectional survey with retrospective chart review. Setting Tertiary care center. Subjects and Methods The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was mailed to 600 patients treated for vestibular schwannoma. Patients were separated by treatment and subsequently subdivided by years of follow-up (0-5, 6-10, and >10 years). Composite quality-of-life (cQOL) scores and subscores for hearing, balance, facial nerve, pain, anxiety, energy, and general health were calculated. Scores were compared among treatment groups as a whole, among treatment groups at each time interval, and within treatment groups over time using a 2-tailed analysis of variance and paired t test. Results The survey return rate was 49%, and the mean follow-up was 7.9 years. The only significant difference in cQOL occurred at 0 to 5 years, where stereotactic radiation scores were better than both microsurgery and observation ( P = .009). No significant differences were detected in cQOL after 5 years. Within the radiation group, cQOL was significantly lower at 6 to 10 years than at 0 to 5 years ( P = .013). At no point was cQOL for stereotactic radiation less than that for observation or microsurgery. Conclusions Long-term (>5 years) quality-of-life outcomes measured by the PANQOL in vestibular schwannoma patients show no significant differences between stereotactic radiation, observation, and microsurgical intervention. Studies are needed to fully evaluate very-long-term QOL for patients with vestibular schwannoma.
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Affiliation(s)
- Zachary N. Robinett
- Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Patrick C. Walz
- Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Beth Miles-Markley
- Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Aaron C. Moberly
- Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - D. Bradley Welling
- Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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Validating the Penn Acoustic Neuroma Quality of Life Scale in a Sample of Dutch Patients Recently Diagnosed With Vestibular Schwannoma. Otol Neurotol 2013; 34:952-7. [DOI: 10.1097/mao.0b013e31828bb2bb] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baschnagel AM, Chen PY, Bojrab D, Pieper D, Kartush J, Didyuk O, Naumann IC, Maitz A, Grills IS. Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery. J Neurosurg 2013; 118:571-8. [DOI: 10.3171/2012.10.jns12880] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea.
Methods
Forty patients with vestibular schwannoma with serviceable hearing were treated using GKS with a median marginal dose of 12.5 Gy (range 12.5–13 Gy) to the 50% isodose volume. Audiometry was performed prospectively before and after GKS at 1, 3, and 6 months, and then every 6 months thereafter. Hearing preservation was based on pure tone average (PTA) and speech discrimination (SD). Serviceable hearing was defined as PTA less than 50 dB and SD greater than 50%.
Results
The median cochlear maximum and mean doses were 6.9 Gy (range 1.6–16 Gy) and 2.7 Gy (range 0.7–5.0 Gy), respectively. With a median audiological follow-up of 35 months (range 6–58 months), the 1-, 2-, and 3-year actuarial rates of maintaining serviceable hearing were 93%, 77%, and 74%, respectively. No patient who received a mean cochlear dose less than 2 Gy experienced serviceable hearing loss (p = 0.035). Patients who received a mean cochlear dose less than 3 Gy had a 2-year hearing preservation rate of 91% compared with 59% in those who received a mean cochlear dose of 3 Gy or greater (p = 0.029). Those who had more than 25% of their cochlea receiving 3 Gy or greater had a higher rate of hearing loss (p = 0.030). There was no statistically significant correlation between serviceable hearing loss and age, tumor size, pre-GKS PTA, pre-GKS SD, pre-GKS Gardner-Robertson class, maximum cochlear dose, or the percentage of cochlear volume receiving 5 Gy. On multivariate analysis there was a trend toward significance for serviceable hearing loss with a mean cochlear dose of 3 Gy or greater (p = 0.074). Local control was 100% at 24 months. No patient developed facial or trigeminal nerve dysfunction.
Conclusions
With a median mean cochlear dose of 2.7 Gy, the majority of patients with serviceable hearing retained serviceable hearing 3 years after GKS. A mean cochlear dose less than 3 Gy was associated with higher serviceable hearing preservation.
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Affiliation(s)
| | - Peter Y. Chen
- 1Department of Radiation Oncology, William Beaumont Hospital
| | | | - Daniel Pieper
- 3Michigan Head and Spine Institute, Royal Oak, Michigan
| | | | - Oksana Didyuk
- 1Department of Radiation Oncology, William Beaumont Hospital
| | | | - Ann Maitz
- 1Department of Radiation Oncology, William Beaumont Hospital
| | - Inga S. Grills
- 1Department of Radiation Oncology, William Beaumont Hospital
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Lin MC, Chen CM, Tseng HM, Xiao F, Young YH. A Proposed Method to Comprehensively Define Outcomes in Acoustic Tumor Patients Undergoing CyberKnife Management. Stereotact Funct Neurosurg 2013; 91:177-85. [DOI: 10.1159/000343215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 09/01/2012] [Indexed: 11/19/2022]
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