To the Editor.—I read with interest the commentary by Drs Brackmann and Kwartler1 entitled "Treatment of Acoustic Tumors With Radiotherapy." As the authors correctly point out, surgical resection of such tumors at a major institution with a large experience remains the gold standard by which to judge alternative treatments.
What the authors failed to mention are the limitations of the data reported from the Karolinska Institute, Stockholm, Sweden. Noren2 has recently updated his experience using the gamma knife to treat 256 acoustic neuromas in 235 patients. He states that only 160 patients had adequate follow-up. The dose administered was quite variable and ranged from 18 to 25 Gy at the periphery of the tumor, with a corresponding maximum dose of 22 to 50 Gy within the central part of the tumor. The tumor size decreased in 37% of the patients, remained stable in 44%, and increased in
FOOTE RL. Treatment of Acoustic Tumors With Radiotherapy. Arch Otolaryngol Head Neck Surg. 1990;116(8):977. doi:10.1001/archotol.1990.01870080099027