TY - JOUR
T1 - Multisession Radiosurgery for Hearing Preservation
AU - Rashid, Abdul
AU - Karam, Sana D.
AU - Rashid, Beenish
AU - Kim, Jeffrey H.
AU - Pang, Dalong
AU - Jean, Walter
AU - Grimm, Jimm
AU - Collins, Sean P.
N1 - Publisher Copyright:
© 2016.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Clinically relevant dose-tolerance limits with reliable estimates of risk in 1-5 fractions for cochlea are still unknown. Timmerman's limits from the October 2008 issue of Seminars in Radiation Oncology have served as the basis for clinical practice, augmented by updated constraints in TG-101 and QUANTEC, but the corresponding estimates of risk have not yet been well-reported. A total of 37 acoustic neuroma CyberKnife cases from Medstar Georgetown University Hospital treated in 3 or 5 fractions were combined with single-fraction Gamma Knife data from the 69 cases in Timmer 2009 to form an aggregate dataset of 106 cochlea cases treated in 1-5 fractions. Probit dose-response modeling was performed in the DVH Evaluator software to estimate normal tissue complication probability. QUANTEC recommends keeping single-fraction maximum dose to the cochlea less than 14 Gy to maintain less than 25% risk of serviceable hearing loss, and our 17.9% risk estimate for 14 Gy in 1 fraction is within their predicted range. In 5 fractions, our estimate of the Timmerman 27.5 Gy maximum cochlea dose limit was 17.4%. For cases in which lower risk is required, the Timmerman 12 Gy in 1 fraction and the TG-101 limit of 25 Gy in 5 fractions had an estimated risk level of 11.8% and 13.8%, respectively. High-risk and low-risk dose tolerance with risk estimates in 1-5 fractions are all presented.
AB - Clinically relevant dose-tolerance limits with reliable estimates of risk in 1-5 fractions for cochlea are still unknown. Timmerman's limits from the October 2008 issue of Seminars in Radiation Oncology have served as the basis for clinical practice, augmented by updated constraints in TG-101 and QUANTEC, but the corresponding estimates of risk have not yet been well-reported. A total of 37 acoustic neuroma CyberKnife cases from Medstar Georgetown University Hospital treated in 3 or 5 fractions were combined with single-fraction Gamma Knife data from the 69 cases in Timmer 2009 to form an aggregate dataset of 106 cochlea cases treated in 1-5 fractions. Probit dose-response modeling was performed in the DVH Evaluator software to estimate normal tissue complication probability. QUANTEC recommends keeping single-fraction maximum dose to the cochlea less than 14 Gy to maintain less than 25% risk of serviceable hearing loss, and our 17.9% risk estimate for 14 Gy in 1 fraction is within their predicted range. In 5 fractions, our estimate of the Timmerman 27.5 Gy maximum cochlea dose limit was 17.4%. For cases in which lower risk is required, the Timmerman 12 Gy in 1 fraction and the TG-101 limit of 25 Gy in 5 fractions had an estimated risk level of 11.8% and 13.8%, respectively. High-risk and low-risk dose tolerance with risk estimates in 1-5 fractions are all presented.
UR - http://www.scopus.com/inward/record.url?scp=84960795407&partnerID=8YFLogxK
U2 - 10.1016/j.semradonc.2015.11.004
DO - 10.1016/j.semradonc.2015.11.004
M3 - Review article
C2 - 27000506
AN - SCOPUS:84960795407
SN - 1053-4296
VL - 26
SP - 105
EP - 111
JO - Seminars in Radiation Oncology
JF - Seminars in Radiation Oncology
IS - 2
ER -