The Long-Term Outcomes of Wait-and-Scan and the Role of Radiotherapy in the Management of Vestibular Schwannomas

Patnaik, Uma; Prasad, Sampath Chandra; Tutar, Hakan; Giannuzzi, Anna Lisa; Russo, Alessandra; Sanna, Mario

doi:10.1097/mao.0000000000000657

Cited by 40 publications

(35 citation statements)

References 54 publications

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“…In principle, it was the natural history of AN that dictated our treatment approach: most small tumours do not grow, but hearing function declines inexorably regardless of tumour growth. The wait-and-see policy is justified by the finding of no tumour growth for a considerable proportion of small tumours 1 2 4 5 18 despite progression of hearing loss. Follow-up seems to be the most predictable variable when assessing hearing outcome – whatever the therapeutic approach – because hearing decline is inescapable when tumours are observed over a long period of time.…”

Section: Discussionmentioning

confidence: 99%

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management

Zanoletti¹,

Cazzador²,

Faccioli³

et al. 2018

Acta Otorhinolaryngol Ital

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Section: Discussionmentioning

confidence: 99%

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management

Zanoletti¹,

Cazzador²,

Faccioli³

et al. 2018

Acta Otorhinolaryngol Ital

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“…The risk of growth after 5 years of follow-up ranges from 0 3 to 7%, 8 with some recent studies having demonstrated tumor growth after many years of follow-up. [9][10][11][12] These studies recommend continuing a lifelong policy of surveillance imaging, albeit at a reduced interval frequency for stable tumors. However, these papers have not specifically focused on the older patient age group, and our data suggest that a policy of discontinuation of imaging surveillance after 5 years tumor stability can be considered in this group.…”

Section: Discussionmentioning

confidence: 99%

When Should We Stop Scanning Older Patients with Vestibular Schwannomas?

et al. 2018

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Objective Observation is a well-accepted management for small- to medium-sized vestibular schwannomas (VSs). Although there are good data on the natural history of this disease within adults, no studies have looked specifically at those aged over 70 years. Thus, there is a need for a surveillance protocol to determine if and when we can stop imaging safely patients aged 70 years and over with a new diagnosis of VSs when managed with observation. Design Over a 13-year period, we retrospectively analyzed all skull base unit patients with a sporadic unilateral VSs managed with an imaging surveillance protocol. All data were collected prospectively with a minimum follow-up of 5 years. Setting Tertiary referral skull base unit Participants Patients aged 70 years and over with sporadic VSs at diagnosis Main Outcome Measures Main outcome measures Results A total of 112 patients met inclusion criteria. The median age at diagnosis was 74 years (range: 70–87 years). The mean follow-up was 82 months (range: 60–144). The size of the VSs at diagnosis was intracanalicular (IC) in 46%, small in 41%, medium in 12%, and large in 2%.Growth was more likely where tumors were extracanalicular (EC) rather than IC at presentation (p = 0.036) and within the first 18 months after diagnosis (p < 0.001). Twenty-nine percent of VSs displayed growth (6% continued surveillance, 23% received active treatment). Good hearing at diagnosis did not predict tumor stability for IC or EC tumors (p = 0.162 and p = 0.536). Conclusions Since no VSs grew after 42 months from diagnosis, our data support an initial magnetic resonance imaging (MRI) at 6 months after diagnosis followed by an annual MRI for 3 years. At this point, consideration could be given to discussing discontinuation or further imaging with patients.

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“…Due to the reported intraoperative complications and resulting postoperative morbidity, in most cases a wait-and-scan policy is adopted for VS. 17 However, an alternative includes radiosurgical management of VS. Adequate control of VS by radiosurgery has been documented.…”

Section: Discussionmentioning

confidence: 99%

Expanded transcanal transpromontorial approach to the internal auditory canal: Pilot clinical experience

et al. 2017

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The Long-Term Outcomes of Wait-and-Scan and the Role of Radiotherapy in the Management of Vestibular Schwannomas

Abstract: The wait-and-scan modality is ideal for management of VSs in the elderly population and also in younger patients with intrameatal tumors. Considering the fact that a large percentage of tumors do not require any form of treatment, the role of RT in VSs needs to be reinvestigated.

Cited by 40 publications

References 54 publications

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management

When Should We Stop Scanning Older Patients with Vestibular Schwannomas?

Expanded transcanal transpromontorial approach to the internal auditory canal: Pilot clinical experience

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