Hearing preservation after LINAC radiosurgery and LINAC radiotherapy for vestibular schwannoma

Linear accelerators (LINAC) can deliver both radiosurgery and fractionated radiotherapy. In this systematic analysis, we compare hearing preservation in patients with vestibular schwannomas (VS) treated with either LINAC-based radiotherapy (SRT) or LINAC-based radiosurgery (SRS), with an emphasis on the prognostic implications of tumor size and patient age. A total of 400 patients met our criteria for LINAC SRS, with an average hearing preservation rate of 66.3%. Patients with smaller tumors (<3.0 cm3) treated with SRS had similar hearing preservation rates to those with larger tumors. However, younger patients (<55 years) demonstrated improved hearing preservation compared to older patients (⩾55 years). When comparing LINAC SRS to LINAC SRT directly, hearing preservation was similar in patients with smaller tumors. However, patients with larger tumors (⩾3.0 cm3) who received SRT had higher hearing preservation rates than those who received SRS. A total of 629 patients met our criteria for LINAC SRT, with an average hearing preservation rate of 75.3%. Patients with larger tumors who received SRT had better hearing outcomes than those with smaller tumors, while there was no significant difference in hearing preservation in younger patients compared to older patients. When comparing LINAC SRS to LINAC SRT directly, younger patients had similar hearing preservation rates. However, older patients who received SRT had improved hearing preservation compared to those who received SRS. In a direct comparison of average hearing preservation, patients who received SRT had higher hearing preservation rates than those who underwent SRS. Prospective studies will be needed to further characterize radiation dose and other variables.