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Background <p>Gamma Knife radiosurgery (GKRS) is an established treatment for vestibular schwannoma, but contemporary cohort-level data integrating long-term tumor control with clinical symptom trajectories and hearing-related correlates remain valuable.</p> Methods <p>We performed a retrospective cohort study of 286 patients with vestibular schwannoma (VS) treated with GKRS (2014–2024). The primary endpoint was local control. Secondary outcomes included overall survival and changes in hearing loss, imbalance, vertigo, dizziness, and tinnitus. Kaplan–Meier analysis was used to estimate local control and overall survival. Paired symptom changes were assessed using McNemar testing.</p> Results <p>The Median follow-up was 52.3 months (IQR 27.4–80.3). Progressive radiographic enlargement occurred in 5 patients, yielding a crude local control rate of 98.3%. The actuarial local control was 98.5% at 5 years and 96.5% at 10 years. Imbalance, vertigo, dizziness, and tinnitus improved significantly after GKRS, whereas hearing loss remained stable overall (59.4% vs. 57.3%, <i>p</i> = 0.441). Mean symptom burden declined from 1.74 to 1.20 symptoms per patient (<i>p</i> &lt; 0.001). Post-radiosurgery hearing loss was more frequent in Koos IV tumors and increased stepwise across quartiles of cochlear mean dose: 38.7% for ≤ 2.9&#xa0;Gy, 53.3% for &gt; 2.9–3.6&#xa0;Gy, 66.2% for &gt; 3.6–4.5&#xa0;Gy, and 73.8% for &gt; 4.5&#xa0;Gy (<i>p</i> = 0.00012). Baseline hearing loss remained the strongest predictor in multivariable modeling.</p> Conclusions <p>At a median of four years GKRS provided tumor control in &gt; 95% of VS patients and was associated with reduced overall symptom burden and improvement in vestibular symptoms. Hearing outcomes were related to baseline auditory status, Koos grade, and cochlear dosimetry.</p> Clinical trial number <p>Not applicable.</p>

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Beyond tumor control: symptom trajectories and hearing outcomes after contemporary Gamma Knife radiosurgery for vestibular schwannoma

  • 期刊论文

  • 发表日期：

    2026年6月23日

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  • Jheremy S. Reyes,
  • Constantinos G. Hadjipanayis,
  • L. Dade Lunsford,
  • Ajay Niranjan

摘要

Background

Gamma Knife radiosurgery (GKRS) is an established treatment for vestibular schwannoma, but contemporary cohort-level data integrating long-term tumor control with clinical symptom trajectories and hearing-related correlates remain valuable.

Methods

We performed a retrospective cohort study of 286 patients with vestibular schwannoma (VS) treated with GKRS (2014–2024). The primary endpoint was local control. Secondary outcomes included overall survival and changes in hearing loss, imbalance, vertigo, dizziness, and tinnitus. Kaplan–Meier analysis was used to estimate local control and overall survival. Paired symptom changes were assessed using McNemar testing.

Results

The Median follow-up was 52.3 months (IQR 27.4–80.3). Progressive radiographic enlargement occurred in 5 patients, yielding a crude local control rate of 98.3%. The actuarial local control was 98.5% at 5 years and 96.5% at 10 years. Imbalance, vertigo, dizziness, and tinnitus improved significantly after GKRS, whereas hearing loss remained stable overall (59.4% vs. 57.3%, p = 0.441). Mean symptom burden declined from 1.74 to 1.20 symptoms per patient (p < 0.001). Post-radiosurgery hearing loss was more frequent in Koos IV tumors and increased stepwise across quartiles of cochlear mean dose: 38.7% for ≤ 2.9 Gy, 53.3% for > 2.9–3.6 Gy, 66.2% for > 3.6–4.5 Gy, and 73.8% for > 4.5 Gy (p = 0.00012). Baseline hearing loss remained the strongest predictor in multivariable modeling.

Conclusions

At a median of four years GKRS provided tumor control in > 95% of VS patients and was associated with reduced overall symptom burden and improvement in vestibular symptoms. Hearing outcomes were related to baseline auditory status, Koos grade, and cochlear dosimetry.

Clinical trial number

Not applicable.