Associations of Microvascular Risk Factors with Sporadic Vestibular Schwannoma Outcomes Following Stereotactic Radiosurgery.

IF 2.6 3区医学 Q1 OTORHINOLARYNGOLOGY Otolaryngology- Head and Neck Surgery Pub Date : 2024-11-07 DOI:10.1002/ohn.1038

James R Dornhoffer, Eric E Babajanian, Karl R Khandalavala, John P Marinelli, Ghazal S Daher, Christine M Lohse, Michael J Link, Matthew L Carlson

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Abstract

Objective: Stereotactic radiosurgery (SRS) is increasingly used for small-to-medium-sized sporadic vestibular schwannoma (VS) and is associated with good tumor control and low-risk of adverse radiation-associated events. The exact mechanism of VS tumor control is unknown but may relate to microvascular hyalinization and resultant tumoral ischemia. This study examined associations of microvascular risk factors with outcomes following SRS.

Design: Historical cohort of patients who underwent SRS for sporadic VS from 2000 to 2022.

Setting: Tertiary academic center.

Methods: Associations of microvascular risk factors with tumor control and complications were evaluated using Cox proportional hazards regression.

Results: In total 749 patients were studied, 31% with a history of smoking, 38% obesity, 19% hypertension, 8% diabetes, 3% peripheral vascular disease, and 2% history of coronary bypass. Regarding tumor control, no factor was associated with salvage treatment following SRS (n = 42). Hypertension (hazard ratio [HR] 2.81; P = .02) and coronary bypass (HR 6.91; P = .002) were significantly associated with developing facial nerve paresis (n = 22). No significant associations with new facial spasms (n = 53) were identified. Lastly, 191 of 294 patients with serviceable hearing at SRS progressed to nonserviceable hearing at a median 2.0 years (interquartile range: 1.0-5.0). After multivariable adjustment for age and ipsilateral hearing status, the HR for the association of smoking history with time to nonserviceable hearing was 1.46 (95% confidence interval 1.04-2.04; P = .03).

Conclusion: We demonstrate that hypertension and history of coronary bypass may be associated with development of facial nerve weakness, while smoking may be associated with accelerated hearing loss in patients undergoing SRS for sporadic VS. These data may help guide patient counseling and inform decision-making regarding treatment.

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微血管风险因素与立体定向放射手术后散发性前庭神经丛瘤疗效的关系

目的：立体定向放射手术（SRS）越来越多地用于治疗中小型散发性前庭裂隙瘤（VS），其肿瘤控制效果好，放射相关不良反应风险低。VS肿瘤控制的确切机制尚不清楚，但可能与微血管透明化和肿瘤缺血有关。本研究探讨了微血管风险因素与 SRS 后果的关系：设计：2000年至2022年因散发性VS接受SRS治疗的患者历史队列：地点：三级学术中心：方法：使用Cox比例危险回归评估微血管风险因素与肿瘤控制和并发症的相关性：共研究了749名患者，其中31%有吸烟史，38%肥胖，19%高血压，8%糖尿病，3%外周血管疾病，2%有冠状动脉搭桥史。在肿瘤控制方面，没有任何因素与SRS后的挽救治疗有关（n = 42）。高血压（危险比 [HR] 2.81；P = .02）和冠状动脉搭桥（HR 6.91；P = .002）与面神经瘫痪的发生有显著相关性（n = 22）。与新发面神经痉挛（n = 53）无明显关联。最后，在 SRS 时听力尚可的 294 名患者中，有 191 人在中位 2.0 年（四分位间范围：1.0-5.0）后发展为听力不可用。在对年龄和同侧听力状况进行多变量调整后，吸烟史与听力丧失时间相关的HR为1.46（95%置信区间为1.04-2.04；P = .03）：我们的研究表明，高血压和冠状动脉搭桥史可能与面神经无力的发生有关，而吸烟可能与因散发性 VS 而接受 SRS 治疗的患者听力加速丧失有关。这些数据有助于指导患者咨询，并为治疗决策提供依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Otolaryngology- Head and Neck Surgery 医学-耳鼻喉科学

CiteScore

6.70

自引率

2.90%

发文量

250

审稿时长

2-4 weeks

期刊介绍： Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.