Quality-of-Life Differences by Treatment Groups for Acoustic Neuroma Patients

Objective: Using the Penn Acoustic Neuroma Quality-of-Life (PANQOL) survey, we examined the differences in quality of life for acoustic neuroma patients undergoing conservative management, stereotactic radiosurgery (gamma knife), and surgery.

Methods: A retrospective chart review of acoustic neuroma patients who completed a PANQOL survey between 10/1/2010 and 2/2/2012 was performed. A total of 97 patients (38 conservative, 38 gamma knife, 21 surgical) were included. Patient demographics, tumor characteristics, audiologic testing, and PANQOL data for the groups were statistically analyzed using the Student t-test, ANOVA with Tukey post hoc test, and chi-square.

Results: The mean patient age of the surgery treatment group (52 ± 14 years) was significantly younger than both the conservative group (60 ± 11 years) and the gamma knife group (64 ± 12 years) (P = 0002). In addition, the surgery group had a significantly higher percentage of women (76 ± 4%) compared with the conservative treatment group (39 ± 5%) (P = 0.021). The mean follow-up time was 2.7 years and was not different between groups (P = 0.40).

Tumor size (mm) was found to be significantly different among the conservative (9 mm ± 5 mm), gamma knife (16 mm ± 6 mm), and surgery (26 mm ± 8 mm) treatment groups (P < 0.000).

Measurements of hearing (speech recognition threshold and speech discrimination percentage) revealed patients in the conservative group displayed significantly better hearing than those of the gamma knife and surgery treatment groups (P < 0.000). No significant difference was detected between the two treatment arms.

There was no significant difference between treatment groups in the PANQOL domains of hearing, balance, facial nerve palsy, pain, anxiety, energy, and the total score. However, the general score was significantly better for the gamma knife (59 ± 15) and surgery (63 ± 16) groups compared with the conservative group (51 ± 13) (P = 0.006).

Conclusion: In analyzing treatment groups, the gamma knife group had significantly larger tumors and worse hearing when compared with the conservative treatment group. The surgery group had significantly younger age, higher percentage of women, larger tumors, and worse hearing. When compared with the gamma knife group, the surgery group had significantly larger tumors and younger patients.

The PANQOL General Well Being domain score was found to be significantly better in the gamma knife and surgery groups compared with the conservative group. This could be due to the conservative group’s increased age and associated medical comorbidities. Although the facial nerve dysfunction score trended toward significantly worse results for the surgery group, no other PANQOL domains were significantly different from one another.

Analyses of these data are limited by study design, which does not allow randomization of patients into different groups. Such a randomized prospective study will likely not occur due to ethical considerations. Thus, it is possible to conclude that at a follow-up period of intermediate length, our current patient treatment algorithm allows for all patients with acoustic neuromas to enjoy a similar quality of life.