Quality Of Life In Patients Treated With Gamma Knife Stereotactic Radiosurgery For Acoustic Neuroma

Keywords: vestibular schwannoma, gamma knife, quality of life, outcome, radiosurgery

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     To evaluate the impact of Gamma Knife (GK) on quality of life (QOL) in patients treated for acoustic neuroma and correlate dizziness handicap scores with labyrinth radiation dose.
     Between December 2006 and October 2009, 88 patients were treated with GK. The study included 44 female and 29 male with median age of 62 y (range 26- 88).
     A prospective clinical follow-up algorithm was developed for patients undergoing GK for acoustic neuroma at a single Institution. In addition to standard follow up, all patients received pre and post-GK QOL questionnaires at 1, 3, 6, and 12 months post-GK. QOL indices included: SF-36 Health Survey, Dizziness Handicap Inventory (DHI), and Tinnitus Handicap Inventory (THI). Electroneurography (ENG) was performed pre and post-GK to evaluate vestibular function and correlate changes with questionnaire scores. Dosimetric parameters for the labyrinth were evaluated for possible correlation with SF-36 and DHI scores.
     The median follow-up was 12 months. Mean tumor volume was 0.373 cc (range 0.026-5.8) with marginal tumor dose of 12.5 Gy. The patients who completed both pre and post-GK questionnaire were SF-36:53.4 % (39/73), THI: 38.4% (28/73), DHI: 60.3% (44/73). Mean baseline QOL score was for SF-36: 92.97, 17.61 for DHI, 20.22 for THI and at last follow up SF-36: 101.32 (p=0.716), THI: 22.04 (p=0.017), DHI: 18.61 (p<0.001). SF-36 scores showed an improvement in QOL at 1 month (p=0.008) and 6 months (p=0.039). At 12 months pre and post-GK scores were not significantly different. The health aspect of SF-36 showed a significant reduction in Emotion Score (72.92 vs 68.81, p<0.001) and Vitality score (67.73 vs 66, p<0.001) post GK. Both THI (20.22 vs 22.04, p=0.017) and DHI (17.61 vs 18.61, p<0.001) were worse after GK but only the DHI differences were statistically significant.
     This is a retrospective study.
     Radiosurgery for acoustic neuroma gives an improvement in QOL in the first 6 months after treatment. Later pre and post-GK differences are not significant.
     Emotional and Vitality functions decline after GK. Dizziness and Tinnitus have a more negative effect on QOL in acoustic patients post-GK. No relationship appears between labyrinth dose and change in DHI and SF-36 scores


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