Hearing loss and volumetric growth rate in untreated vestibular schwannoma

2021 ◽  
pp. 1-8
Author(s):  
Jason Gurewitz ◽  
Zane Schnurman ◽  
Aya Nakamura ◽  
Ralph E. Navarro ◽  
Dev N. Patel ◽  
...  
Keyword(s):  
Growth Rate ◽  
Hearing Loss ◽  
Tumor Growth ◽  
Growth Rates ◽  
Volumetric Growth ◽  
Class A ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Initial Tumor ◽  
Initial Tumor Size

OBJECTIVE In this study, the authors aimed to clarify the relationship between hearing loss and tumor volumetric growth rates in patients with untreated vestibular schwannoma (VS). METHODS Records of 128 treatment-naive patients diagnosed with unilateral VS between 2012 and 2018 with serial audiometric assessment and MRI were reviewed. Tumor growth rates were determined from initial and final tumor volumes, with a median follow-up of 24.3 months (IQR 8.5–48.8 months). Hearing changes were based on pure tone averages, speech discrimination scores, and American Academy of Otolaryngology–Head and Neck Surgery hearing class. Primary outcomes were the loss of class A hearing and loss of serviceable hearing, estimated using the Kaplan-Meier method and with associations estimated from Cox proportional hazards models and reported as hazard ratios. RESULTS Larger initial tumor size was associated with an increased risk of losing class A (HR 1.5 for a 1-cm3 increase; p = 0.047) and serviceable (HR 1.3; p < 0.001) hearing. Additionally, increasing volumetric tumor growth rate was associated with elevated risk of loss of class A hearing (HR 1.2 for increase of 100% per year; p = 0.031) and serviceable hearing (HR 1.2; p = 0.014). Hazard ratios increased linearly with increasing growth rates, without any evident threshold growth rate that resulted in a large, sudden increased risk of hearing loss. CONCLUSIONS Larger initial tumor size and faster tumor growth rates were associated with an elevated risk of loss of class A and serviceable hearing.

A prospective study of hearing preservation in untreated vestibular schwannomas

2011 ◽  
Vol 114 (2) ◽  
pp. 381-385 ◽  
Author(s):  
Michael E. Sughrue ◽  
Ari J. Kane ◽  
Rajwant Kaur ◽  
Jeffrey J. Barry ◽  
Martin J. Rutkowski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Growth Rate ◽  
Hearing Loss ◽  
Tumor Growth ◽  
Median Time ◽  
Tumor Size ◽  
Vestibular Schwannomas ◽  
Tumor Growth Rate ◽  
Initial Tumor ◽  
Initial Tumor Size

Object The authors previously published a systematic review of the English language literature regarding the natural history of untreated vestibular schwannomas (VSs). This analysis found that the best predictor of future hearing loss was tumor growth > 2.5 mm/year on serial imaging, a factor that doubled the rate of hearing loss. In this paper the authors present an analysis of prospectively collected outcomes in patients with untreated VS from their institution that confirms their previous findings. Methods Clinical, radiographic, and audiometric data for all patients evaluated for VS at the authors' institution over a 22-year period were prospectively collected in a database. All patients in this database who had serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery Grade A or B) on initial presentation were selected, and underwent serial observation. Magnetic resonance imaging and audiometric data were analyzed, and the time from presentation until hearing loss was analyzed using Kaplan-Meier analysis. Results Fifty-nine patients with VS who initially presented with serviceable hearing were treated conservatively over this period. Consistent with the authors' previous findings, patients with a tumor growth rate > 2.5 mm/year at any point during follow-up lost their hearing at a much faster rate than those who had slower growing tumors. The median time to hearing loss was 7.0 years in those patients with tumor growth rate > 2.5 mm/year compared to 14.8 years in the other patients (p < 0.0001). The estimated median time to hearing loss in the 3 initial tumor size groups was 11.6 years in the intracanalicular group, 10.3 years in the group with 0.1–1 cm extension into the CPA cistern, and 9.3 years in the group with > 1 cm extension into the CPA cistern (p value nonsignificant). Initial tumor size, age at diagnosis, and neurofibromatosis Type 2 status did not affect the time to loss of serviceable hearing. Interestingly, many patients who were followed up for more than a decade eventually lost their hearing, regardless of whether the tumor displayed any documented interval growth. Conclusion The authors confirmed the findings of their systematic review of the literature using a prospectively followed group of patients with untreated VS. Collectively, these data suggest that the expectation for more rapid hearing loss should be communicated to patients, and the decision for surgical or other intervention should be made in the context of the known risk of continued observation of fast growing tumors.

The Natural History of Incidental Meningiomas

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Julia Michel ◽  
Cornelius Jacobs ◽  
Madjid Samii
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Growth ◽  
Growth Rates ◽  
Tumor Size ◽  
Annual Growth ◽  
Tumor Doubling Time ◽  
History Of ◽  
Doubling Times ◽  
Initial Tumor Size

Abstract OBJECTIVE Little information about the natural history of incidental meningiomas exists in the literature. The aim of this study was to determine the natural history of asymptomatic meningiomas by comparing different methods of growth rate calculation to establish a strategy for dealing with these tumors. METHODS In 47 asymptomatic patients, hospital charts, follow-up records, and imaging studies were reviewed. Of these patients, 6 underwent surgery. Tumor growth rates were determined by calculating the absolute and relative growth rates and the tumor volume doubling times. RESULTS In 41 patients with conservative management, the average tumor size was 9 cm3, and the majority (66%) of growth rates were less than 1 cm3/yr. The absolute growth rate ranged from 0.03 to 2.62 cm3/yr (mean, 0.796 cm3/yr). Relative annual growth rates ranged from 0.48 to 72.8% (mean, 14.6%). The tumor doubling time ranged from 1.27 to 143.5 years (mean, 21.6 yr). A moderate correlation between the age and growth rates was found. In young patients, annual growth rates tended to be higher and tumor doubling times shorter. There was no clear correlation between the initial tumor size and tumor doubling time. The mean annual growth rate of meningiomas with calcification was lower than in tumors without calcification. Also, tumors with hypointense or isointense T2 signals on magnetic resonance imaging had a lower growth rate. In the group of six patients with surgical excision, tumor growth rates were higher and tumor doubling times shorter than in the nonsurgical group. CONCLUSION The majority of incidental meningiomas show minimal growth; thus, they may be observed without surgical intervention unless specific symptoms appear. Tumor growth is associated with patient age. The initial tumor size is not considered a predictive factor for tumor growth. Radiological features, such as calcification or T2 signal intensity, may provide useful information to predict the growth potential of meningiomas.

scholarly journals Volumetric analysis of IDH-mutant lower-grade glioma: a natural history study of tumor growth rates before and after treatment

2020 ◽  
Vol 22 (12) ◽  
pp. 1822-1830
Author(s):  
Raymond Y Huang ◽  
Robert J Young ◽  
Benjamin M Ellingson ◽  
Harini Veeraraghavan ◽  
Wei Wang ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Growth Rates ◽  
World Health ◽  
Lower Grade ◽  
Volumetric Growth ◽  
Mixed Effect ◽  
Inversion Recovery Imaging ◽  
Significant Difference ◽  
Before And After

Abstract Background Lower-grade gliomas (LGGs) with isocitrate dehydrogenase 1 and/or 2 (IDH1/2) mutations have long survival times, making evaluation of treatment efficacy difficult. We investigated the volumetric growth rate of IDH mutant gliomas before and after treatment with established glioma therapies to determine whether a significant change in growth rate could be documented and perhaps be used in the future to evaluate treatment response to investigational agents in LGG trials. Methods In this multicenter retrospective study, 230 adult patients with IDH1/2 mutated LGGs (World Health Organization grade II or III) undergoing surgery, radiation, or chemotherapy for progressive non-enhancing tumor were identified. Subjects were required to have 3 MRI scans containing T2/fluid attenuated inversion recovery imaging spanning a minimum of 6 months prior to treatment. A mixed-effect model was used to estimate tumor growth prior to treatment. A subset of 95 patients who received chemotherapy, radiotherapy, or chemoradiotherapy and had 2 posttreatment imaging time points available were evaluated for change in pre- and posttreatment volumetric growth rates using a piecewise mixed model. Results The pretreatment volumetric growth rate across all 230 patients was 27.37%/180 days (95% CI: [23.36%, 31.51%]). In the 95 patients with both pre- and posttreatment scans available, there was a significant difference in volumetric growth rates before (26.63%/180 days, 95% CI: [19.31%, 34.40%]) and after treatment (−15.24% /180 days, 95% CI: [−21.37%, −8.62%]) (P &lt; 0.0001). The growth rates for patient subgroup with 1p/19q codeletion (N = 118) was significantly slower than the rate of the 1p/19q non-codeleted group (N = 68) (22.84% vs 35.49%, P = 0.0108). Conclusion In this study, we evaluated the growth rates of IDH mutant gliomas before and after standard therapy. Further study is needed to establish whether a change in growth rate is associated with patient survival and its use as a surrogate endpoint in clinical trials for IDH mutant LGGs.

The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes

2010 ◽  
Vol 112 (1) ◽  
pp. 163-167 ◽  
Author(s):  
Michael E. Sughrue ◽  
Isaac Yang ◽  
Derick Aranda ◽  
Khadja Lobo ◽  
Lawrence H. Pitts ◽  
...  
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Growth ◽  
Tumor Size ◽  
Management Options ◽  
Hearing Outcome ◽  
Initial Tumor ◽  
History Of ◽  
Initial Tumor Size

Object Observation is an important consideration when discussing management options for patients with vestibular schwannoma (VS). Most data regarding clinical outcomes after conservative management come from modestsized series performed at individual centers. The authors performed an analysis of the published literature on the natural history of VSs with respect to hearing outcome. Their objective was to provide a comprehensive and unbiased description of outcomes in patients whose disease was managed conservatively. Methods The authors identified a total of 34 published studies containing hearing outcome data in patients with VSs < 25 mm in largest diameter who underwent observation management. The effects of initial tumor size and tumor growth rate on hearing function at latest follow-up were analyzed. Data from individual and aggregated cases were extracted from each study. Patients with poorer hearing (American Association of Otolaryngology–Head and Neck Surgery Classes C or D, or Gardner-Robertson Classes III, IV, or V) at the time of presentation were excluded. Results A total of 982 patients met the inclusion criteria for this analysis, with a mean initial tumor size of 11.3 ± 0.68 mm. The mean growth rate was 2.9 ± 1.2 mm/year. The length of follow-up for these studies ranged from 26 to 52 months. Patients with preserved hearing at latest follow-up had a statistically larger initial tumor size than those whose hearing declined during the observation period (11.5 ± 2.3 mm vs 9.3 ± 2.7 mm, p < 0.0001), but the 2-mm difference of means was at the limit of imaging resolution and observer reliability. In contrast, patients with lower rates of tumor growth (≤ 2.5 mm/year) had markedly higher rates of hearing preservation (75 vs 32%, p < 0.0001) compared with patients with higher tumor growth rates. Interestingly, the authors' analysis found no difference in the rate of reported intervention for patients in either group (16 vs 18%, p = not significant). Conclusions These data suggest that a growth rate of > 2.5 mm/year is a better predictor of hearing loss than the initial tumor size for patients undergoing observation management of VSs < 25 mm in largest diameter.

Tumor Progression Following Petroclival Meningioma Subtotal Resection: A Volumetric Study

2017 ◽  
Vol 14 (3) ◽  
pp. 215-223 ◽  
Author(s):  
Jacob B Hunter ◽  
Brendan P O’Connell ◽  
Matthew L Carlson ◽  
Lola C Chambless ◽  
Robert J Yawn ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Tumor Volume ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Volumetric Growth ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas ◽  
The Mean

Abstract BACKGROUND One study has investigated postoperative growth rates following subtotal resection of petroclival meningiomas utilizing linear measurements, which are insensitive to the multidimensional complex growth of meningiomas, to estimate tumor volume. OBJECTIVE To describe petroclival meningioma growth patterns following less-than-complete resection utilizing volumetric analysis and to identify variables associated with tumor progression. METHODS Patients with surgically resected WHO grade I petroclival meningiomas were retrospectively reviewed (1999-2015). Image analysis software was utilized to perform volumetric analyses of tumor size and growth on serial MRI studies. The impact of preoperative and postoperative variables on tumor growth after subtotal resection was analyzed. An increase in tumor volume of at least 20% was defined as “tumor growth.” RESULTS Twenty-three patients had immediate preoperative and serial postoperative MRI studies available for review. The mean preoperative tumor volume was 20.9 cm3 (range 0.4-54.6). The mean extent of resection was 75.5% (range 31.5%-100.0%). At a mean follow-up of 24.8 mo, 12 tumors (66.7%) exhibited radiological tumor growth, while 6 tumors did not change in size. The median annual volumetric growth rate was 2.82 cm3/yr (range –0.34 to 10.1). Extent of resection and immediate postoperative tumor volume were significantly correlated with the annual volumetric growth rate following resection. At last follow-up, 3 (13%) patients required further intervention. CONCLUSION The majority of petroclival meningiomas exhibit growth following subtotal resection. Extent of resection is strongly associated with risk for disease progression following surgery.

scholarly journals Increased Risk of Sudden Sensory Neural Hearing Loss in Osteoporosis: A Longitudinal Follow-Up Study

2018 ◽  
Vol 103 (8) ◽  
pp. 3103-3109 ◽  
Author(s):  
So Young Kim ◽  
Il Gyu Kong ◽  
Hyun Lim ◽  
Hyo Geun Choi
Keyword(s):  
Hearing Loss ◽  
The Elderly ◽  
National Sample ◽  
Control Group ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Korean National Health Insurance ◽  
Sensory Neural ◽  
Sensory Neural Hearing Loss

Abstract Context The results of a previous population cohort study suggested an association between osteoporosis and sudden sensory neural hearing loss (SSNHL). Objectives To use a nationwide cohort in the Korean population to investigate the risk of SSNHL in patients with osteoporosis. Design, Setting, and Participants Data entered from 2002 to 2013 were collected from the Korean National Health Insurance Service-National Sample Cohort. A total of 68,241 patients with osteoporosis aged ≥50 years were matched with 68,241 control individuals. The crude (simple) and adjusted hazard ratios (HRs) of SSNHL in those with osteoporosis were analyzed using the Cox proportional hazard model. A subgroup analysis was performed according to age and sex. Results The risk of SSNHL was greater in the osteoporosis group than in the control group (adjusted HR, 1.56; 95% CI, 1.37 to 1.78; P &lt; 0.001). The risk of SSNHL in those with osteoporosis was greater in patients aged &lt;60 years, regardless of sex. Women aged ≥60 years had a higher HR for SSNHL in the presence of osteoporosis (women aged 60 to 69 years: adjusted HR, 1.67; 95% CI, 1.34 to 2.08; P &lt; 0.001; women aged ≥70 years: adjusted HR, 1.90; 95% CI, 1.29 to 2.79; P &lt; 0.001). Conclusions The risk of SSNHL was greater for patients with osteoporosis aged ≥50 years. Middle-age adults, as well as the elderly, are at an increased risk of SSNHL in the presence of osteoporosis.

Hearing Loss and Volumetric Growth Rate in Observed Vestibular Schwannoma Patients

2021 ◽  
Author(s):  
Zane Schnurman ◽  
Jason Gurewitz ◽  
Aya Nakamura ◽  
John Golfinos ◽  
J. Thomas Roland Jr ◽  
...  
Keyword(s):  
Growth Rate ◽  
Hearing Loss ◽  
Vestibular Schwannoma ◽  
Volumetric Growth

scholarly journals RTHP-28. TTFIELDS TREATMENT AFFECTS TUMOR GROWTH RATES: A POST-HOC ANALYSIS OF THE PIVOTAL PHASE 3 EF-14 TRIAL

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi215-vi215
Author(s):  
Noa Urman ◽  
Gitit Lavy-Shahaf ◽  
Shay levi ◽  
Ze’ev Bomzon
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Growth Rates ◽  
Tumor Volume ◽  
Progression Free Survival ◽  
Local Tumor Control ◽  
Tumor Growth Rate ◽  
Tumor Control ◽  
Pivotal Phase ◽  
Tumor Treating Fields

Abstract INTRODUCTION The pivotal EF-14 trial showed that Tumor Treating Fields (TTFields) extend Progression Free Survival (PFS) in newly Diagnosed Glioblastoma (ndGBM) patients. This leads to the hypothesis that TTFields therapy leads to local control of tumors, yielding a significant decrease in tumor growth rates. Here we present an analysis testing this hypothesis in biopsy-only patients who participated in the EF-14 trial. METHODS Biopsy patients of the EF-14 trial who exhibited radiological progression were included in this study (treatment: N=37/60, control: N=12/29). Volumes of enhancing tumor were segmented on T1c MRIs at baseline and at progression. Tumor growth rate was calculated as: growth_rate=(ln(v0)-ln(v1))/dt. (v0- tumor volume at baseline), v1- Tumor volume at progression, dt- days to progression), which models tumor volume as increasing exponentially over time. Median growth rates in the treatment and control arms were compared. RESULTS The median growth rate was lower in the treatment arm than in the control. (control: 0.14±0.12 mL/month, TTFields -0.011±0.11 mL/month, p< 0.008 Wilcoxon rank-sum) DISCUSSION AND CONCLUSIONS This study shows that tumor growth rates are slower in patients treated with TTFileds+Temozolomide (TMZ) than in patients treated with TMZ alone. This analysis was restricted to biopsy-only patients since the definition of tumor volume is ambiguous in patients that underwent resection since a large portion of the tumor has been removed. The negative median growth rate for patients in the treatment arm may indicate that a significant number of TTFields-treated patients a decrease in tumor volume was observed, suggesting that TTFields enhances local tumor control. References: [1] Stupp, Roger, et al. Jama 318.23 (2017): 2306–2316.[[2 Stensjøen, Anne Line, et al. Neuro-oncology 17.10 (2015): 1402–1411.

Ten-Year Follow-up on Tumor Growth and Hearing in Patients Observed With an Intracanalicular Vestibular Schwannoma

Neurosurgery ◽  
2016 ◽  
Vol 80 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Malene Kirchmann ◽  
Kirstine Karnov ◽  
Søren Hansen ◽  
Thomas Dethloff ◽  
Sven-Eric Stangerup ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Word Recognition ◽  
Tumor Growth ◽  
Vestibular Schwannoma ◽  
Recognition Score ◽  
Class A ◽  
Number Of Patients ◽  
Term Data

Abstract BACKGROUND: Reports on the natural history of tumor growth and hearing in patients with a vestibular schwannoma (VS) are almost exclusively short-term data. Long-term data are needed for comparison with results of surgery and radiotherapy. OBJECTIVE: To report the long-term occurrence of tumor growth and hearing loss in 156 patients diagnosed with an intracanalicular VS and managed conservatively. METHODS: In this longitudinal cohort study, diagnostic and follow-up magnetic resonance imaging and audiometry were compared. RESULTS: After a follow-up of 9.5 years, tumor growth had occurred in 37% and growth into the cerebellopontine angle had occurred in 23% of patients. Conservative treatment failed in 15%. The pure tone average had increased from 51- to 72-dB hearing level, and the speech discrimination score (SDS) had decreased from 60% to 34%. The number of patients with good hearing (SDS &gt; 70%) was reduced from 52% to 22%, and the number of patients with American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) class A hearing was reduced from 19% to 3%. Hearing was preserved better in patients with 100% SDS at diagnosis than in patients with even a small loss of SDS. Serviceable hearing was preserved in 34% according to AAO-HNS (class A-B) and in 58% according to the word recognition score (class I-II). Rate of hearing loss was higher in patients with growing tumors. CONCLUSION: Tumor growth occurred in only a minority of patients diagnosed with an intracanalicular VS during 10 years of observation. The risk of hearing loss is small in patients with normal discrimination at diagnosis. Serviceable hearing is preserved spontaneously in 34% according to AAO-HNS and in 58% according to the word recognition score.

A Comparison of Growth Rates of Acoustic Neuromas: Nonsurgical Patients vs. Subtotal Resection

1993 ◽  
Vol 109 (3) ◽  
pp. 482-487 ◽  
Author(s):  
Seth I. Rosenberg ◽  
Herbert Silverstein ◽  
Michael A. Gordon ◽  
John M. Flanzer ◽  
Thomas O. Willcox ◽  
...  
Keyword(s):  
Growth Rate ◽  
Elderly Patients ◽  
Tumor Growth ◽  
Brain Stem ◽  
Growth Rates ◽  
Tumor Growth Rate ◽  
Subtotal Resection ◽  
Average Growth ◽  
Patients Âgés ◽  
Acoustic Neuromas

A conservative approach to the management of acoustic neuromas in elderly patients has been used since 1971. Elderly patients without symptoms of brain stem compression are initially treated by observation and yearly radiographic imaging. A translabyrinthine radical-subtotal resection is performed if brain stem compression is present or if tumor is growing rapidly. Twenty-three patients, ages 65 to 86 years, had initial nonsurgical management of their tumors. Growth rates could be determined for 16 patients. Thirteen patients not requiring surgery had an average tumor growth rate of 0.6 mm/yr. Three patients with an average growth rate of 6.8 mm/yr eventually required surgery. No patient whose tumor was < 15 mm at initial evaluation has experienced brain stem symptoms or demonstrated rapid tumor growth. Twenty-four patients ages 65 to 86 years underwent planned subtotal tumor excision. Eighteen patients followed postoperatively for more than 1 year demonstrated an average rate of regrowth of tumor of 0.7 mm/yr. (OTOLARYNGOL HEAD NECK SURG 1993;109:482-7.)

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