Longitudinal Comparison of Quality-of-Life Outcomes in Vestibular Schwannoma Patients

Abstract

Objectives:

1) Compare long-term quality of life (QOL) outcomes in vestibular schwannoma (VS) patients managed conservatively, with microsurgery, or with stereotactic radiation; 2) Evaluate factors contributing to their QOL.

Methods:

The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was administered to 645 patients treated for VS at a tertiary care center over 24 years. Patients in each treatment group were sub-divided by years since diagnosis (0-5, 6-10, and >10). Composite QOL (cQOL) scores and sub-scores in hearing, balance, facial symptoms, pain, anxiety, and energy were compared by ANOVA at each time interval. Regression analysis correlated QOL with tumor size, speech recognition threshold, and reported symptoms.

Results:

Survey return rate was 49%. Mean follow-up was 7.6 years. The only significant difference in cQOL was at 1-5 years, where stereotactic radiation was best and conservative treatment was worst (P = .009). No significant differences in cQOL were detected at 6-10 or >10 years. Significant differences between sub-scores were found in hearing, balance, and facial symptoms. Overall tumor size was inversely proportional to QOL (R = .54; P < .001); this correlation decreased with time (1-5 R = .61, P < .001 / 6-10 R = .40, P < .001 / >10 R = .16, P = .02).

Conclusions:

1) We found no significant difference in long-term QOL outcomes between treatment groups; however, patients treated by stereotactic radiation may experience better overall QOL up to 5 years post-treatment. 2) Tumor size at presentation is a good prognostic tool in VS patients but may be limited in predicting long-term QOL outcomes.