Natural History of Growing Sporadic Vestibular Schwannomas During Observation: An International Multi-Institutional Study

Marinelli, John P.; Carlson, Matthew L.; Hunter, Jacob B.; Nassiri, Ashley M.; Haynes, David S.; Link, Michael J.; Lohse, Christine M.; Reznitsky, Martin; Stangerup, Sven‐Eric; Cayé‐Thomasen, Per

doi:10.1097/mao.0000000000003224

Cited by 14 publications

(13 citation statements)

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“…There is no internationally agreed or widely accepted management protocol resulting in great variability among different clinical centers (12). However, the advancement of clinical and diagnostic tools has increased the detection of tumors that are at an earlier stage and smaller in size (13); hence, many clinical centers have started to incline toward a more conservative approach; where a ''watch and wait'' protocol is implemented allowing to observe the tumor's natural history with successive magnetic resonance imaging scans, while active treatment with stereotactic radiosurgery (SRS) or surgical resection is reserved for larger tumors or in cases of evident tumor growth (14,15). Other factors playing a role in the decisionmaking process include the degree of hearing loss and patient's age, general condition, and preference (16,17).…”

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confidence: 99%

Comparing Hearing Outcomes in Irradiated and Conservatively Managed Vestibular Schwannoma

Ismail

Sobhy

Assal

et al. 2022

Otology &Amp; Neurotology

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Objective: Compare hearing outcome for vestibular schwannoma patients following stereotactic radiosurgery (SRS) or conservative management. Study Design: Retrospective review. Setting: University Hospital. Patients: Patients with small-or medium-sized sporadic vestibular schwannoma (intracanalicular or with CPA component <2 cm) who were managed conservatively or underwent SRS with available clinical, radiological, and audiometric data from the time of presentation (or just before radiotherapy for the SRS group) and most recent follow-up; with the two sets of data to be compared being at least 3 years apart (minimum follow-up period). Interventions: SRS or observation. Main Outcome Measure: Pure-tone averages, speech discrimination scores, and corresponding hearing classifications. Results: Two hundred forty-seven patients met our inclusion criteria; 140 were managed conservatively with a mean follow-up period of 5.9 AE 1.6 years and 107 underwent SRS with a mean follow-up period of 7.1 AE 1.9 years. There was significant deterioration of hearing measures for both groups; with the SRS group displaying consistently worse measures. SRS patients showed worse mean pure-tone averages and speech discrimination scores decline rates by 2.72 dB/yr and 2.98 %/yr, respectively, when compared with conservatively managed patients. Stratifying patients according to Tokyo's hearing classification revealed that 68.75% of conservatively managed patients who had baseline serviceable hearing preserved their hearing throughout the studied period compared with only 15.38% of the SRS patients. Conclusion: Based on our data we conclude that patients with small-and medium-sized tumors will have a better hearing outcome if managed via an initial conservative approach with radiotherapy reserved for those demonstrating disease progression.

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confidence: 99%

Comparing Hearing Outcomes in Irradiated and Conservatively Managed Vestibular Schwannoma

Ismail

Sobhy

Assal

et al. 2022

Otology &Amp; Neurotology

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“…The incidence of VS was historically reported as 1 case per 100,000 before the development of MRI technology, but the actual incidence is much higher. As recently reported by Marinelli et al (1), the actual lifetime prevalence may be as high as 1 per 500 for sporadic VS.…”

Section: Introductionmentioning

confidence: 62%

The Impact of Social Determinants of Health on Vestibular Schwannoma Management: A Single Institution Review

Ellsperman¹,

Bellile²,

Fryatt

et al. 2023

Otol Neurotol

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ObjectiveTo evaluate social determinants of health and their effect on the management of vestibular schwannoma (VS).Study DesignRetrospective chart review.SettingTertiary referral center.PatientsPatients >18 years old with sporadic VS newly diagnosed between January 1, 2010, and December 31, 2020.Intervention(s)Magnetic resonance imaging; audiogram; treatment recommendations.Main Outcome Measure(s)Differences in treatment recommendations for patients based on their social determinants of health, including race, ethnicity, and socioeconomic status.ResultsA total of 811 patients were included in analysis. Patients with a higher area deprivation index (ADI) presented with larger tumors. A higher ADI was associated with a higher likelihood of recommending radiation (or the option of surgery or radiation) compared with a recommendation of surgery alone. Tumor grade and patient age were significantly associated with treatment recommendation. Older age was associated with a recommendation of observation alone or a recommendation of radiation. Higher tumor grade was associated with a recommendation of surgery. There was a trend for higher hearing class to be associated with a recommendation of surgery, but this did not reach statistical significance. Race, ethnicity, and gender were not significantly associated with treatment recommendation.ConclusionsPatients with higher levels of disadvantage presented with higher tumor grade, suggesting that access to care influences diagnosis. Factors including age, ADI, and tumor grade were associated with treatment recommendation.

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“…This pattern was reproduced even after tumors were initially found to demonstrate growth, where 25% of tumors that had previously demonstrated growth had shown evidence of volumetric tumor regression after 5 years of additional follow-up with MRI. Unlike data examining the probability of future tumor growth (12,16,17), no feature examined in the current work reliably predicted future volumetric tumor regression. Lastly, although elevated rates of tumor shrinkage were observed when compared with previous linear tumor measurement studies, ultimately only 82 of the 952 patients studied exclusively demonstrated tumor shrinkage without growth at some point during the tumor's natural history.…”

Section: Discussionmentioning

confidence: 91%

Spontaneous Volumetric Tumor Regression During Wait-and-Scan Management of 952 Sporadic Vestibular Schwannomas

et al. 2022

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ObjectiveSpontaneous tumor shrinkage during wait-and-scan management of sporadic vestibular schwannoma is generally considered an uncommon phenomenon. However, most data informing this understanding stem from single-slice linear tumor measurements taken in the axial imaging plane. The objective of the current work was to characterize the regression capacity of sporadic vestibular schwannomas using volumetric tumor measurements.Study DesignRetrospective cohort study using slice-by-slice, three-dimensional volumetric tumor measurements.SettingThree tertiary referral centers.PatientsPatients with sporadic vestibular schwannoma.InterventionsWait-and-scan.Main Outcome MeasuresRegression-free survival rates with regression defined as a decrease of at least 20% of the tumor volume.ResultsAmong 952 patients undergoing a total of 3,505 magnetic resonance imaging studies during observation, 123 experienced volumetric tumor regression after diagnosis at a median of 1.2 years (interquartile range, 0.6–2.9 yr). Volumetric regression-free survival rates (95% confidence interval; number still at risk) at 1, 3, and 5 years after diagnosis were 94% (92–95%; 662), 86% (83–89%; 275), and 78% (73–82%; 132), respectively. Among 405 patients who demonstrated an initial period of tumor growth but continued wait-and-scan management, 48 experienced volumetric regression at a median of 1.2 years (interquartile range, 0.8–2.6 yr) after initial growth. Volumetric regression-free survival rates at 1, 3, and 5 years after initial growth were 94% (92–97%; 260), 84% (79–89%; 99), and 75% (67–83%; 43), respectively. Ultimately, only 82 of the 952 patients studied showed exclusively volumetric tumor regression (i.e., without any periods of tumor growth) by the time of last follow-up.ConclusionSpontaneous volumetric tumor shrinkage during wait-and-scan management occurs more frequently than suggested by previous studies using linear tumor measurements and can even occur after previous episodes of documented tumor growth. These data further highlight the dynamic nature of vestibular schwannoma growth. To this end, the application of natural history data to patient management requires a nuanced approach that parallels the complex tumor behavior of vestibular schwannoma.

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Natural History of Growing Sporadic Vestibular Schwannomas During Observation: An International Multi-Institutional Study

Cited by 14 publications

References 21 publications

Comparing Hearing Outcomes in Irradiated and Conservatively Managed Vestibular Schwannoma

Comparing Hearing Outcomes in Irradiated and Conservatively Managed Vestibular Schwannoma

The Impact of Social Determinants of Health on Vestibular Schwannoma Management: A Single Institution Review

Spontaneous Volumetric Tumor Regression During Wait-and-Scan Management of 952 Sporadic Vestibular Schwannomas

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