At Jefferson we have among the most extensive experience with fractionated stereotactic radiotherapy (FSR) in the world and our publications reflect our innovations with this technique for benign tumors. Our experience reflects among the highest published rates for serviceable hearing preservation for patients with acoustic neuromas. Below is a summary table of recently published outcomes after treatment of acoustic neuromas with single fraction stereotactic radiosurgery (SRS), proton beam therapy, and FSR.

Author	Treatment	Serviceable Hearing Preservation Rate
Weber (2003)1	Proton beam therapy	20%
Vernimmen (2009)2	Proton beam therapy	42%
Regis (2008)3	SRS	60%
Chopra (2007)4	SRS	56%
Koh (2007)5	FSR	77%
Andrews (2009)6	FSR	79%

In the most recent Acoustic Neuroma Association 2007-2008 Patient Survey (available online at www, patients self-reported that FSR techniques, although varying in number of fractions and fraction size yielded the highest rates of serviceable hearing preservation when compared to SRS.

Treatment Technique	respondents self-reported THEIR HEARING1
	At diagnosis	After treatment
SRS	108 (100%)	22 (20%)
FSR	84 (100%)	41 (48%)

¹Based on the Gardner-Robertson Hearing Grading Scale

Published data from peer-reviewed refereed journals as well as self-reported data from acoustic neuroma patients therefore support the treatment of acoustic neuromas with FSR as the treatment of choice when patients still have serviceable hearing, since FSR seems more likely to preserve hearing long-term than single fraction radiosurgery (SRS) or proton beam therapy.

1. Weber DC, Chan AW, Bussiere MR, et al. Proton beam radiosurgery for vestibular schwannoma: tumor control and cranial nerve toxicity. Neurosurgery 2003;53(3):577-86; discussion 86-8.
2. Vernimmen FJ, Mohamed Z, Slabbert JP, Wilson J. Long-term results of stereotactic proton beam radiotherapy for acoustic neuromas. Radiother Oncol 2009;90(2):208-12.
3. Regis J, Tamura M, Delsanti C, Roche PH, Pellet W, Thomassin JM. Hearing preservation in patients with unilateral vestibular schwannoma after gamma knife surgery. Prog Neurol Surg 2008;21:142-51.
4. Chopra R, Kondziolka D, Niranjan A, Lunsford LD, Flickinger JC. Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 2007;68(3):845-51.
5. Koh ES, Millar BA, Menard C, et al. Fractionated stereotactic radiotherapy for acoustic neuroma: single-institution experience at The Princess Margaret Hospital. Cancer 2007;109(6):1203-10.
6. Andrews D, Werner-Wasik M, Den R, et al. Toward dose optimization of fractionated stereotactic radiotherapy for acoustic neuromas: comparison of two dose cohorts. International Journal of Radiation Oncology BIology Physics 2009:in press.