TY - JOUR
T1 - Wait-and-scan management in sporadic Koos grade 4 vestibular schwannomas
T2 - A longitudinal volumetric study
AU - Schouten, Sammy M
AU - Cornelissen, Stefan
AU - Langenhuizen, Patrick P H J
AU - Jansen, Thijs T G
AU - Mulder, Jef J S
AU - Derks, Jolanda
AU - Verheul, Jeroen B
AU - Kunst, Henricus P M
PY - 2023/11/3
Y1 - 2023/11/3
N2 - BACKGROUND: Volumetric natural history studies specifically on large vestibular schwannomas (VSs), commonly classified as Koos grade 4, are lacking. The aim of the current study is to present the volumetric tumor evolution in sporadic Koos grade 4 VSs and possible predictors for tumor growth. METHODS: Volumetric tumor measurements and tumor evolution patterns from serial MRI studies were analyzed from selected consecutive patients with Koos grade 4 VS undergoing initial wait-and-scan management between January 2001 and July 2020. The significant volumetric threshold was defined as a change in volume of =10%. RESULTS: Among 215 tumors with a median size (IQR) of 2.7 cm (1.8-4.2), 147 tumors (68%) demonstrated growth and 75 tumors (35%) demonstrated shrinkage during follow-up. Growth-free survival rates (95% CI) at 1, 2, 5, and 10 years were 55% (48-61), 36% (29-42), 29% (23-36), and 28% (21-34), respectively and did not significantly differ in tumors> 20 mm (Chi-square = .40; -value = .53). Four tumor evolution patterns (% of total) were observed: continued growth (60); initial growth then shrinkage (7); continued shrinkage (27); and stability (5). Good hearing (adjusted HR 2.21, 95% CI 1.48-3.30; < .001) and peritumoral edema (adjusted HR 2.22, 95% CI 1.18-4.13; = .01) at diagnosis were significantly associated with an increased likelihood of growth. CONCLUSIONS: Koos grade 4 VSs show a wide variety in size and growth. Due to variable growth patterns, an initial wait-and-scan strategy with short scan intervals may be an acceptable option in selected tumors, if no significant clinical symptoms of mass effect that warrant treatment are present.
AB - BACKGROUND: Volumetric natural history studies specifically on large vestibular schwannomas (VSs), commonly classified as Koos grade 4, are lacking. The aim of the current study is to present the volumetric tumor evolution in sporadic Koos grade 4 VSs and possible predictors for tumor growth. METHODS: Volumetric tumor measurements and tumor evolution patterns from serial MRI studies were analyzed from selected consecutive patients with Koos grade 4 VS undergoing initial wait-and-scan management between January 2001 and July 2020. The significant volumetric threshold was defined as a change in volume of =10%. RESULTS: Among 215 tumors with a median size (IQR) of 2.7 cm (1.8-4.2), 147 tumors (68%) demonstrated growth and 75 tumors (35%) demonstrated shrinkage during follow-up. Growth-free survival rates (95% CI) at 1, 2, 5, and 10 years were 55% (48-61), 36% (29-42), 29% (23-36), and 28% (21-34), respectively and did not significantly differ in tumors> 20 mm (Chi-square = .40; -value = .53). Four tumor evolution patterns (% of total) were observed: continued growth (60); initial growth then shrinkage (7); continued shrinkage (27); and stability (5). Good hearing (adjusted HR 2.21, 95% CI 1.48-3.30; < .001) and peritumoral edema (adjusted HR 2.22, 95% CI 1.18-4.13; = .01) at diagnosis were significantly associated with an increased likelihood of growth. CONCLUSIONS: Koos grade 4 VSs show a wide variety in size and growth. Due to variable growth patterns, an initial wait-and-scan strategy with short scan intervals may be an acceptable option in selected tumors, if no significant clinical symptoms of mass effect that warrant treatment are present.
KW - Koos grade 4
KW - observation
KW - vestibular schwannoma
KW - volumetric growth
KW - wait-and-scan
U2 - 10.1093/noajnl/vdad144
DO - 10.1093/noajnl/vdad144
M3 - Article
SN - 2632-2498
VL - 6
SP - 1
EP - 10
JO - Neuro-Oncology Advances
JF - Neuro-Oncology Advances
IS - 1
M1 - vdad144
ER -