TY - JOUR
T1 - Natural History of Growing Sporadic Vestibular Schwannomas
T2 - An Argument for Continued Observation Despite Documented Growth in Select Cases
AU - Marinelli, John P.
AU - Lees, Katherine A.
AU - Lohse, Christine M.
AU - Driscoll, Colin L.W.
AU - Neff, Brian A.
AU - Link, Michael J.
AU - Van Gompel, Jamie J.
AU - Carlson, Matthew L.
N1 - Publisher Copyright:
© 2020, Otology & Neurotology, Inc.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Objective: Definitive treatment of sporadic vestibular schwannoma (VS) following documented growth is common practice at most centers in the United States. However, as a natural extension of this paradigm, very little evidence exists surrounding the natural history of growing tumors. The primary objective of the current work was to describe the natural history of sporadic VS following documentation of initial tumor growth. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Patients diagnosed with sporadic VS between January 1, 2001 and December 31, 2015 who elected continued observation despite having volumetric growth ≥20% of original tumor volume on interval magnetic resonance imaging (MRI). Main Outcome Measure: Survival free of subsequent volumetric growth. Results: Of 361 patients undergoing observation with serial imaging during the study period, 85 patients met inclusion criteria at a median age of 66 years (interquartile ranges [IQR] 55-71). Within this cohort, 40 patients demonstrated subsequent volumetric growth at a median of 1.7 years (IQR 1.0-2.6) from the date of initial MRI that documented growth. The median volumetric growth was 43% (IQR 28-57), and the median growth rate was 0.026 cm3 per year (IQR 0.009-0.107). Survival free of subsequent volumetric growth rates (95% CI; number still at risk) at 1, 2, 3, 4, and 5 years were 93% (87-99; 75), 67% (58-79; 45), 54% (43-67; 29), 44% (33-59; 19), and 41% (30-56; 12), respectively. Conclusions: In a cohort exclusively comprised of sporadic VS with documented growth, over 40% of tumors demonstrated no subsequent volumetric growth after 5 years of continued MRI surveillance. These data challenge the supposition that once growth occurs, all tumors will exhibit sustained growth. Continued observation after documented growth of sporadic VS is a reasonable consideration in appropriately selected cases.
AB - Objective: Definitive treatment of sporadic vestibular schwannoma (VS) following documented growth is common practice at most centers in the United States. However, as a natural extension of this paradigm, very little evidence exists surrounding the natural history of growing tumors. The primary objective of the current work was to describe the natural history of sporadic VS following documentation of initial tumor growth. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Patients diagnosed with sporadic VS between January 1, 2001 and December 31, 2015 who elected continued observation despite having volumetric growth ≥20% of original tumor volume on interval magnetic resonance imaging (MRI). Main Outcome Measure: Survival free of subsequent volumetric growth. Results: Of 361 patients undergoing observation with serial imaging during the study period, 85 patients met inclusion criteria at a median age of 66 years (interquartile ranges [IQR] 55-71). Within this cohort, 40 patients demonstrated subsequent volumetric growth at a median of 1.7 years (IQR 1.0-2.6) from the date of initial MRI that documented growth. The median volumetric growth was 43% (IQR 28-57), and the median growth rate was 0.026 cm3 per year (IQR 0.009-0.107). Survival free of subsequent volumetric growth rates (95% CI; number still at risk) at 1, 2, 3, 4, and 5 years were 93% (87-99; 75), 67% (58-79; 45), 54% (43-67; 29), 44% (33-59; 19), and 41% (30-56; 12), respectively. Conclusions: In a cohort exclusively comprised of sporadic VS with documented growth, over 40% of tumors demonstrated no subsequent volumetric growth after 5 years of continued MRI surveillance. These data challenge the supposition that once growth occurs, all tumors will exhibit sustained growth. Continued observation after documented growth of sporadic VS is a reasonable consideration in appropriately selected cases.
KW - Acoustic neuroma
KW - Conservative management
KW - Growth
KW - Natural history
KW - Observation
KW - Vestibular schwannoma
KW - Volumetric
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U2 - 10.1097/MAO.0000000000002756
DO - 10.1097/MAO.0000000000002756
M3 - Article
C2 - 32925859
AN - SCOPUS:85091051152
SN - 1531-7129
VL - 41
SP - E1149-E1153
JO - Otology and Neurotology
JF - Otology and Neurotology
IS - 9
ER -