Conservative treatment of patients with acoustic tumors

Abstract

Seventy of 178 patients with acoustic tumors initially were treated conservatively and have been followed up for an average of 26 +/- 2 months. The tumor size was determined by the mean maximum anteroposterior and mediolateral diameters, using computed tomographic or magnetic resonance imaging scans obtained sequentially throughout the follow-up period. The average tumor growth was 1.6 +/- 0.4 mm the 1st year, and 1.9 +/- 1.0 mm the 2nd year (range, -2 to 17 mm/y): 4 tumors showed apparent regression, 28 (40%) had no detectable growth, and 37 (53%) exhibited growth (average, 3.8 +/- 1.2 mm/y). Within individual patients, the tumor growth rate determined during the 1st year of follow-up was predictive of tumor growth rate determined during the following year. Rapid tumor growth or clinical deterioration in 9 of the 70 patients (13%) who initially were treated conservatively necessitated subsequent surgery an average of 14 +/- 5 months after the patient was initially seen. This group had a larger initial tumor size (27.0 +/- 3.4 mm vs. 21.3 +/- 0.9 mm, P less than 0.05), and a faster 1-year growth rate (7.9 +/- 2.3 mm/y vs. 1.3 +/- 0.3 mm/y, P less than 0.05) than the 61 patients who did not require surgery. Two patients, however, experienced neurological deterioration that required surgery, even though there was no tumor growth. The high incidence of acoustic tumors with no detectable growth or apparent spontaneous regression must be taken into account when evaluating the indications for surgery and the efficacy of radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Predictors of future growth of sporadic vestibular schwannomas obtained by history and radiologic assessment of the tumor

“…Tschudi et al [13] found that patients with progressive hearing loss as a Wrst symptom had a signiWcantly lower tumor growth than those presenting with tinnitus, sudden hearing loss and vertigo. Other studies, however, revealed no signiWcant diVerences in age, gender, tumor laterality, initial symptoms, duration of symptoms or initial tumor size between patients with growing tumors and non-growing tumors [7,11,12,14]. A possible predictor of growth may be the duration of symptoms.…”

“…Fucci et al [11] reported a signiWcantly increased growth rate of tumors with a maximal diameter larger than 20 mm at presentation. Some studies found that tumor growth in the Wrst year could be indicative for future growth [12,13]. Furthermore the symptoms of the patients have been considered as possible predictors of growth.…”

Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

“…The natural history of VSs is not well known; retrospective studies suggest that 53% continuously grow and 7% to 10% remain stable, whereas up to 30% involute (16). A few prospective series showed that untreated VSs regress in 7% to 20% of cases and remain stable in 40% to 85% (2, 17–21) whereas only 18% to 55% tumors show progression (2, 17–19, 21).…”

Reproducibility of volume measurements of vestibular schwannomas – a preliminary study

“…The traditional method of assessing tumour size is a single (axial) linear measurement. [5][6][7][8][9][10][11][12][13] This approach is relatively simple, quick and does not require a computer workstation but has disadvantages. First, the choice of which axial measurement to make is not straightforward.…”