Vestibular schwannoma

An understanding of growth should influence management decisions

Clementino Arturo Solares, Benedict Panizza

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND: Treatments for vestibular schwannomas include surgical removal and radiotherapy. Observation is a reasonable alternative, given the slow growth of these tumors. The goal of this study was to determine the 5-year no-growth rate in patients managed initially by observation in attempts to define indications for treatment. STUDY DESIGN: Retrospective chart analysis of prospectively collected patient database. METHODS: Patients with unilateral vestibular schwannomas who presented in the last 10 years were reviewed. Those managed initially by observation were reviewed. At least 2 consecutive imaging studies were required. The following information was recorded from the charts: age, sex, tumor size at presentation and subsequent follow-up sessions, treatment in the event of growth, and time interval between presentation and last imaging available. The institutional ethics committee approved the study. RESULTS: One hundred ten patients were included. There were 65 male patients and 45 female patients. The mean age was 62.4 years (range, 32-91 yr). The mean follow-up was 31.4 months (range, 6-156 mo). Twenty-three patients demonstrated evidence of growth, with an overall 5-year no-growth rate of 70.6%. Despite growth, the 5-year no-intervention rate was 81.3%. Interestingly, 11 patients (10%) demonstrated tumor regression. Patients with intracanalicular tumors had a 5-year no-growth rate of 89.8% compared with 73.9% and 45.2% for Grade I and Grade II or larger tumors, respectively. The difference between intracanalicular and Grade II or larger tumors was statistically significant (p = 0.0196). CONCLUSION: Our data suggest that treatment can be delayed in a large proportion of vestibular schwannoma patients and that this is particularly true in patients with small tumors. Despite growth, only a small percentage of patients require intervention. Thus, we recommend a period of observation to determine the need for treatment in patients without indications for urgent intervention.

Original languageEnglish (US)
Pages (from-to)829-834
Number of pages6
JournalOtology and Neurotology
Volume29
Issue number6
DOIs
StatePublished - Sep 1 2008

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Acoustic Neuroma
Growth
Neoplasms
Observation
Therapeutics
Ethics Committees
Radiotherapy

Keywords

  • Acoustic neuroma
  • Growth
  • Natural history
  • Radiation therapy
  • Surgery
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology
  • Sensory Systems
  • Medicine(all)

Cite this

Vestibular schwannoma : An understanding of growth should influence management decisions. / Solares, Clementino Arturo; Panizza, Benedict.

In: Otology and Neurotology, Vol. 29, No. 6, 01.09.2008, p. 829-834.

Research output: Contribution to journalArticle

Solares, Clementino Arturo ; Panizza, Benedict. / Vestibular schwannoma : An understanding of growth should influence management decisions. In: Otology and Neurotology. 2008 ; Vol. 29, No. 6. pp. 829-834.
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abstract = "BACKGROUND: Treatments for vestibular schwannomas include surgical removal and radiotherapy. Observation is a reasonable alternative, given the slow growth of these tumors. The goal of this study was to determine the 5-year no-growth rate in patients managed initially by observation in attempts to define indications for treatment. STUDY DESIGN: Retrospective chart analysis of prospectively collected patient database. METHODS: Patients with unilateral vestibular schwannomas who presented in the last 10 years were reviewed. Those managed initially by observation were reviewed. At least 2 consecutive imaging studies were required. The following information was recorded from the charts: age, sex, tumor size at presentation and subsequent follow-up sessions, treatment in the event of growth, and time interval between presentation and last imaging available. The institutional ethics committee approved the study. RESULTS: One hundred ten patients were included. There were 65 male patients and 45 female patients. The mean age was 62.4 years (range, 32-91 yr). The mean follow-up was 31.4 months (range, 6-156 mo). Twenty-three patients demonstrated evidence of growth, with an overall 5-year no-growth rate of 70.6{\%}. Despite growth, the 5-year no-intervention rate was 81.3{\%}. Interestingly, 11 patients (10{\%}) demonstrated tumor regression. Patients with intracanalicular tumors had a 5-year no-growth rate of 89.8{\%} compared with 73.9{\%} and 45.2{\%} for Grade I and Grade II or larger tumors, respectively. The difference between intracanalicular and Grade II or larger tumors was statistically significant (p = 0.0196). CONCLUSION: Our data suggest that treatment can be delayed in a large proportion of vestibular schwannoma patients and that this is particularly true in patients with small tumors. Despite growth, only a small percentage of patients require intervention. Thus, we recommend a period of observation to determine the need for treatment in patients without indications for urgent intervention.",
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