Stratifying Risk of Future Growth Among Sporadic Vestibular Schwannomas
John P. Marinelli, Zane Schnurman, Daniel E. Killeen, Ashley M. Nassiri, Jacob B. Hunter, Katherine A. Lees, Christine M. Lohse, J. Thomas Roland, John G. Golfinos, Douglas Kondziolka, Michael J. Link, Matthew L. Carlson- Neurology (clinical)
- Sensory Systems
- Otorhinolaryngology
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;
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.