Comparing Linear and Volumetric Tumor Measurements During Observation of Growing Sporadic Vestibular Schwannomas

Killeen, Daniel E.; Marinelli, John P.; Lohse, Christine M.; Lees, Katherine A.; Link, Michael J.; Carlson, Matthew L.; Hunter, Jacob B.

doi:10.1002/ohn.290

Cited by 1 publication

(2 citation statements)

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“…For instance, in the current study, many tumors within the subset of 90 that demonstrated aggressive volumetric doubling during observation had modest growth on linear tumor measurementssometimes demonstrating similar linear tumor size changes compared with tumors with slower volumetric growth rates. This concept has been demonstrated previously, where a small number of tumors can exhibit substantial volumetric changes that is not always appreciated by linear tumor measurements (23). Lastly, because the subset of patients with volumetric doubling was identified as having a nearly guaranteed likelihood of experiencing further growth, corresponding linear tumor sizes are presented to illustrate the general type of linear tumor growth that corresponded to volumetric doubling to provide better clinical context (Table 4).…”

Section: Fig 2 Illustrative Clinical Examples Of Patients Who Exhibit...mentioning

confidence: 78%

“…When volumetric measurements are used to study the natural history of vestibular schwannoma, a commonly raised concern surrounds the reality that volumetric measurements are not currently used clinically at most centers. Addressing this, it is important to first recognize that linear and volumetric tumor measurements bear a strong correlation with one another for both intracanalicular tumors as well as tumors with cerebellopontine angle extension (23). Second, volumetric measurements are more sensitive and can detect growth before linear growth is detected (24).…”

Section: Fig 2 Illustrative Clinical Examples Of Patients Who Exhibit...mentioning

confidence: 99%

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Stratifying Risk of Future Growth Among Sporadic Vestibular Schwannomas

et al. 2023

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Objective In certain cases, clinicians may consider continued observation of a vestibular schwannoma after initial growth is detected. The aim of the current work was to determine if patients with growing sporadic vestibular schwannomas could be stratified by the likelihood of subsequent growth based on initial growth behavior. Study Design Slice-by-slice volumetric tumor measurements from 3,505 serial magnetic resonance imaging studies were analyzed from 952 consecutively treated patients. Setting Three tertiary-referral centers. Patients Adults with sporadic vestibular schwannoma. Interventions Wait-and-scan. Main Outcome Measures Composite end point of subsequent growth- or treatment-free survival rates, where growth is defined as an additional increase of at least 20% in tumor volume from the volume at the time of initial growth. Results Among 405 patients who elected continued observation despite documented growth, stratification, of volumetric growth rate into less than 25% (reference: n = 107), 25 to less than 50% (hazard ratio [HR], 1.39; p = 0.06; n = 96), 50 to less than 100% (HR, 1.71; p = 0.002; n = 112), and at least 100% (HR, 2.01; p < 0.001; n = 90) change per year predicted the likelihood of future growth or treatment. Subsequent growth- or treatment-free survival rates (95% confidence interval) at year 5 after detection of initial growth were 31% (21–44%) for those with less than 25% growth per year, 18% (10–32%) for those with 25 to less than 50%, 15% (9–26%) for those with 50 to less than 100%, and 6% (2–16%) for those with at least 100%. Neither patient age (p = 0.15) nor tumor volume at diagnosis (p = 0.95) significantly differed across stratification groups. Conclusions At the time of diagnosis, clinical features cannot consistently predict which tumors will ultimately display aggressive behavior. Stratification by volumetric growth rate at the time of initial growth results in a stepwise progression of increasing likelihood of subsequent growth. When considering continued observation after initial growth detection, almost 95% of patients who have tumors that double in volume between diagnosis and the first detection of growth demonstrate further tumor growth or undergo treatment if observed to 5 years.

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Section: Fig 2 Illustrative Clinical Examples Of Patients Who Exhibit...mentioning

confidence: 78%

Section: Fig 2 Illustrative Clinical Examples Of Patients Who Exhibit...mentioning

confidence: 99%