Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment

2009 ◽  
Vol 110 (4) ◽  
pp. 662-669 ◽  
Author(s):  
Wissame El Bakkouri ◽  
Romain E. Kania ◽  
Jean-Pierre Guichard ◽  
Guillaume Lot ◽  
Philippe Herman ◽  
...  
Keyword(s):  
Growth Rate ◽  
Mr Imaging ◽  
Tumor Growth ◽  
Conservative Management ◽  
Tumor Size ◽  
Imaging Study ◽  
Tumor Growth Rate ◽  
Slow Growth Rate ◽  
Delay In Diagnosis

Object The object of this study was to evaluate the natural history, pattern, and occurrence of tumor growth and its consequences for treatment of small-sized vestibular schwannomas (VSs). Methods From 1990 to 2005, 386 patients underwent conservative management for VS because of the following: age > 60 years, poor health/medical risks, risk of deterioration of good hearing, small tumor size, minimal or no incapacitating symptoms, and/or patient preference. Tumor size was measured by MR imaging according to the guidelines of the Committee on Hearing and Equilibrium. The first MR imaging study was performed 1 year after diagnosis, and subsequent imaging was performed yearly or every 2 years depending on the appearance of new symptoms, tumor growth, or both. Results Sixty-one patients were lost to follow-up the first year after presentation. Of the 325 patients for whom 1-year follow-up data were available, 39 showed tumor growth ≥ 3 mm. Conservative management was discontinued for these 39 patients. The patients who returned for follow-up were evaluated at 1- or 2-year intervals depending on tumor growth. The authors extrapolated to obtain data for 2-year intervals, yielding data for 160, 56, 21, and 8 patients at 3, 5, 7, and 9 years after initial presentation, respectively. The overall mean tumor growth rate (±standard deviation) was 1.15 ± 2.4 mm/year. This rate was estimated by pooling all values of tumor growth that had been determined for all patients and dividing by the total number of “events,” with each assessment constituting an event. In 58.6% of patients, the annual tumor growth rate was < 1 mm/year; in 29.2%, 1–3 mm/year; and in 12.2%, ≥ 3 mm/ year. The growth rates of intrameatal (1.02 ± 1.8 mm/year) and extrameatal (1.40 ± 3.1 mm/year) tumors did not differ significantly. No significant association was found between tumor growth rate and sex, age, initial hearing status, or initial tumor grade. Delay in diagnosis was the only significant factor associated with tumor growth rate. During follow-up, conservative management was discontinued for 77 (23.7%) of the 325 patients for whom at least 12-month follow-up data were available; surgery was performed in 60 (77.9%) and radiation therapy in 17 (22.1%). Conclusions The results of this study support the role of a conservative “wait-and-scan” policy of management for small-sized VSs because most have a slow growth rate. Long-term neuroimaging follow-up is needed even with non-growing tumors.

Growth kinetics and outcomes of cT1b renal masses under active surveillance.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 440-440
Author(s):  
Reza Mehrazin ◽  
Marc C. Smaldone ◽  
Alexander Kutikov ◽  
Jeffrey J. Tomaszewski ◽  
Tianyu Li ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Metastatic Disease ◽  
Growth Kinetics ◽  
Tumor Size ◽  
Renal Tumors ◽  
Tumor Growth Rate ◽  
Renal Masses ◽  
Delayed Intervention

440 Background: The natural history of untreated T1b renal masses is poorly understood. We assessed the growth kinetics and outcomes of ≥cT1b cortical renal tumors which continue to remain on radiographic AS compared to those who underwent definitive surgery after a period of AS. Methods: Prospectively maintained, renal tumor database was reviewed to identify enhancing solid and cystic masses managed expectantly from 2000-2012. cT1a masses, transitional cell carcinoma or those suspected for metastatic disease were excluded from analysis. Localized tumors > 4.0 cm (≥T1b) that were radiographically followed for > 6 months were included for analysis. Clinical and pathological records were reviewed to determine tumor growth rate and clinical outcomes in those remained on AS or those who underwent delayed intervention. Mean for tumor size on presentation, annual linear tumor growth rate (LGR), Charlson comorbidity index (CCI), and follow-up (FU) were calculated. Chi−square test & Logistic regression were used for uni- and multi-variable analyses. Results: Of 457 pts managed with AS, 67 cT1b tumors (in 63 patients) were identified. 43 pts (67%) were managed solely with AS, while 21 pts (33%) progressed to intervention. The median age at presentation pts managed with AS and intervention was 77 and 60 yrs respectively (p=0.0002), while no difference was observed in median CCI (3 vs. 2, p=0.6). No difference was observed in tumor size at presentation between pts managed with AS and those undergoing delayed intervention (5.9 vs. 5.4 cm, p=0.8). In contrast, the mean LGR significantly differed between pts managed expectantly and pts progressed to intervention (0.37 vs. 0.73 cm/yr; p=0.02). On MVA, age (OR=0.9,CI:0.8−0.98) and LGR (OR=11,CI:1.8−60) were significant predictors of surgical intervention. With a mean FU period of 38.9 ± 24.0 months (6−105), 9 pts died (14%) from other cause and no pt progressed to metastatic disease. Conclusions: Localized cT1b≥ renal masses show comparable growth rates to small tumors managed expectantly with low rates of progression to metastatic disease with short term follow up. An initial period of AS to determine tumor growth kinetics is a reasonable option in select pts with significant competing risks and limited life expectancy.

Conservative Treatment of Patients with Acoustic Tumors

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 646-651 ◽  
Author(s):  
Joshua B. Bederson ◽  
Klaus von Ammon ◽  
Werner W. Wichmann ◽  
Gazi M. Yasargil
Keyword(s):  
Growth Rate ◽  
Conservative Treatment ◽  
Tumor Growth ◽  
Tumor Size ◽  
Tumor Growth Rate ◽  
Computed Tomographic ◽  
High Incidence ◽  
The Mean ◽  
Slow Growing

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 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&lt;0.05), and a faster 1-year growth rate (7.9 ± 2.3 mm/y vs. 1.3 ± 0.3 mm/y, P&lt;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. Beacuse surgery carries some risk and acoustic tumors are generally slow growing, a trial of conservative treatment is possible in selected patients, provided serial radiological studies are obtained. Knowledge of the tumor growth rate established by these studies may be helpful in the treatment of individual patients.

Conservative Management or Gamma Knife Radiosurgery for Vestibular Schwannoma

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 48-57 ◽  
Author(s):  
Cathrine Nansdal Breivik ◽  
Roy Miodini Nilsen ◽  
Erling Myrseth ◽  
Paal Henning Pedersen ◽  
Jobin K. Varughese ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Conservative Management ◽  
Regression Models ◽  
Gamma Knife Radiosurgery ◽  
Rank Test ◽  
Tumor Growth Rate ◽  
Log Rank Test

Abstract BACKGROUND: There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124). OBJECTIVE: The aim was to measure the effect of GKRS compared with the natural course on tumor growth rate and hearing loss. Secondary end points were postinclusion additional treatment, quality of life (QoL), and symptom development. METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QoL assessment by SF-36 questionnaire. Statistics were performed by using Spearman correlation coefficient, Kaplan-Meier plot, Poisson regression model, mixed linear regression models, and mixed logistic regression models. RESULTS: Mean follow-up time was 55.0 months (26.1 standard deviation, range 10-132). Thirteen patients were lost to follow-up. Serviceable hearing was lost in 54 of 71 (76%) (CM) and 34 of 53 (64%) (GKRS) patients during the study period (not significant, log-rank test). There was a significant reduction in tumor volume over time in the GKRS group. The need for treatment following initial GKRS or CM differed at highly significant levels (log-rank test, P &lt; .001). Symptom and QoL development did not differ significantly between the groups. CONCLUSION: In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.

Conservative Management of Bilateral Vestibular Schwannomas in Neurofibromatosis Type 2 Patients: Hearing and Tumor Growth Results

Neurosurgery ◽  
2013 ◽  
Vol 72 (6) ◽  
pp. 907-914 ◽  
Author(s):  
Matthieu Peyre ◽  
Stéphane Goutagny ◽  
Alpha Bah ◽  
Daniele Bernardeschi ◽  
Béatrice Larroque ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Conservative Management ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Tumor Growth Rate ◽  
Tumor Diameter ◽  
The Mean

Abstract BACKGROUND: As new treatment modalities develop for the management of vestibular schwannomas (VS) in patients with neurofibromatosis type 2, it remains crucial to ascertain the natural history of the disease. OBJECTIVE: To determine the relationship between hearing and tumor growth in patients undergoing conservative VS management. METHODS: Patients harboring bilateral VS with at least 1 year of radiological follow-up were selected. Conservative management was proposed based on the small tumor size and/or serviceable hearing at presentation. Tumor size was calculated by using the 2-component box model and reported as mean tumor diameter. Hearing was evaluated by using pure-tone average and the American Academy of Otololaryngologists and Head and Neck Surgery classification. RESULTS: Forty-six patients harboring 92 VS were included. The mean clinical and radiological follow-up times were 6.0 and 4.2 years, respectively. The mean tumor diameter was 13 mm at presentation and 20 mm at the end of follow-up. Mean tumor growth rate was 1.8 mm/year. During follow-up, 17 patients (37%) underwent surgery for VS. Surgery-free rate for VS was 88% at 5 years. The number of patients with at least 1 serviceable ear was 39 (85%) at presentation and 34 (74%) at the end of follow-up, including 22 (66%) with binaural serviceable hearing maintained. There was no statistical correlation between tumor growth rate and preservation of serviceable hearing. Tumor growth rates and age at presentation were inversely correlated. CONCLUSION: This study illustrates the high variability among neurofibromatosis type 2 patients regarding hearing status and VS growth rate and justifies the choice of initial conservative management in selected cases.

scholarly journals Developing an optimal follow-up strategy based on the natural history of nonfunctioning pituitary adenomas

2019 ◽  
Vol 131 (2) ◽  
pp. 500-506 ◽  
Author(s):  
Jung Hee Kim ◽  
Yun-Sik Dho ◽  
Yong Hwy Kim ◽  
Jung Hyun Lee ◽  
Ji Hyun Lee ◽  
...  
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Growth ◽  
Visual Function ◽  
Pituitary Adenomas ◽  
Tumor Volume ◽  
Volume Growth ◽  
Tumor Growth Rate ◽  
Mri Study

OBJECTIVEThe natural history and proper algorithm for follow-up testing of nonfunctioning pituitary adenomas (PAs) are not well known, despite their relatively high prevalence. The aim of this study was to suggest the optimal follow-up algorithm for nonfunctioning PAs based on their natural history.METHODSThe authors followed up 197 patients with nonfunctioning PAs that had not been treated (including surgery and radiation therapy) at the time of detection, in a single center, between March 2000 and February 2017. They conducted a hormone test, visual field test, and MRI at the time of diagnosis and yearly thereafter.RESULTSThe overall median follow-up duration was 37 months. Microadenomas (n = 38) did not cause visual disturbance, pituitary apoplexy, or endocrine dysfunction. The incidence of patients with tumor volume growth ≥ 20% was higher for macroadenomas than microadenomas (13.8 vs 5.0 per 100 person-years [PYs], p = 0.002). The median time to any tumor growth was 4.8 years (95% CI 3.4–4.8 years) for microadenomas and 4 years (95% CI 3.3–4.2 years) for macroadenomas. The overall incidence of worsening visual function was 0.69 per 100 PYs. Patients with a tumor volume growth rate ≥ 0.88 cm3/year (n = 20) had a higher incidence of worsening visual function (4.69 vs 0.30 per 100 PYs, p < 0.001). The tumor growth rate of all microadenomas was < 0.88 cm3/year. The median time to tumor growth ≥ 20% was 3.3 years (95% CI 1.8–3.9 years) in patients with a tumor growth rate ≥ 0.88 cm3/year and 4.9 years (95% CI 4.6–7.2 years) in patients with a tumor growth rate < 0.88 cm3/year.CONCLUSIONSThe authors have devised a follow-up strategy based on the tumor volume growth rate as well as initial tumor volume. In patients with microadenomas, the next MRI study can be performed at 3 years. In patients with macroadenomas, the second MRI study should be performed between 6 months and 1 year to assess the tumor growth rate. In patients with a tumor growth rate ≥ 0.88 cm3/year, the MRI study should be performed within 2 years. In patients with a tumor growth rate < 0.88 cm3/year, the MRI study can be delayed until 4 years.

Small Renal Masses Managed With Active Surveillance: Predictors of Tumor Growth Rate After Long-Term Follow-Up

2015 ◽  
Vol 13 (2) ◽  
pp. e87-e92 ◽  
Author(s):  
Riccardo Schiavina ◽  
Marco Borghesi ◽  
Hussam Dababneh ◽  
Lorenzo Bianchi ◽  
Barbara Longhi ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Active Surveillance ◽  
Tumor Growth Rate ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Long Term Follow Up

Factors that Affect Metastasis in Virus-Induced Mouse Mammary Tumors

1984 ◽  
Vol 70 (2) ◽  
pp. 131-136
Author(s):  
Fulvio Basolo ◽  
Gabriella Fontanini ◽  
Francesco Squartini
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Mammary Tumor ◽  
Tumor Size ◽  
Tumor Metastasis ◽  
Lung Metastases ◽  
High Growth ◽  
High Growth Rate ◽  
Tumor Growth Rate ◽  
Tumor Virus

Two hundred and forty-one mammary tumor-bearing breeding female mice of the BALB/cf C3H and BALB/cfRIII strains, carrying milk-transmitted murine mammary tumor virus (MuMTV) of C3H and RIII origin, respectively, were studied to evaluate the factors that affect tumor metastasis. Only lung metastases were considered and the following factors taken in account: MuMTV inducing variant (C3H, RIII), number of deliveries, tumor histo-type, number of tumors per mouse, clinical duration of tumors, tumor size, and tumor growth rate. Only the number of deliveries, the tumor size and the number of tumors per mouse were found to significantly influence the rate of metastasis. The tumor growth rate affects concurrently with tumor size the metastatic process. In fact, the larger the tumor the higher the tumor growth rate. This direct relationship is significant (P < 0.01) and, in case of lung metastases at autopsy, there was a prevalence of large tumors (> 2 cm) and high growth rate (> 0.3 mm/day). The discordance of these data with those concerning mammary tumor metastasis in virgin females of the same two strains, the enhancing effect of pregnancies on metastatic spread of tumors, and the significance of results for the understanding of the general mechanisms of tumor metastasis are discussed.

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