Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Otol Neurotol. 2022 Oct 1;43(9):e1034-e1038. doi: 10.1097/MAO.0000000000003651. Epub 2022 Aug 20.
Spontaneous tumor shrinkage during wait-and-scan management of sporadic vestibular schwannoma is generally considered an uncommon phenomenon. However, most data informing this understanding stem from single-slice linear tumor measurements taken in the axial imaging plane. The objective of the current work was to characterize the regression capacity of sporadic vestibular schwannomas using volumetric tumor measurements.
Retrospective cohort study using slice-by-slice, three-dimensional volumetric tumor measurements.
Three tertiary referral centers.
Patients with sporadic vestibular schwannoma.
Wait-and-scan.
Regression-free survival rates with regression defined as a decrease of at least 20% of the tumor volume.
Among 952 patients undergoing a total of 3,505 magnetic resonance imaging studies during observation, 123 experienced volumetric tumor regression after diagnosis at a median of 1.2 years (interquartile range, 0.6-2.9 yr). Volumetric regression-free survival rates (95% confidence interval; number still at risk) at 1, 3, and 5 years after diagnosis were 94% (92-95%; 662), 86% (83-89%; 275), and 78% (73-82%; 132), respectively. Among 405 patients who demonstrated an initial period of tumor growth but continued wait-and-scan management, 48 experienced volumetric regression at a median of 1.2 years (interquartile range, 0.8-2.6 yr) after initial growth. Volumetric regression-free survival rates at 1, 3, and 5 years after initial growth were 94% (92-97%; 260), 84% (79-89%; 99), and 75% (67-83%; 43), respectively. Ultimately, only 82 of the 952 patients studied showed exclusively volumetric tumor regression (i.e., without any periods of tumor growth) by the time of last follow-up.
Spontaneous volumetric tumor shrinkage during wait-and-scan management occurs more frequently than suggested by previous studies using linear tumor measurements and can even occur after previous episodes of documented tumor growth. These data further highlight the dynamic nature of vestibular schwannoma growth. To this end, the application of natural history data to patient management requires a nuanced approach that parallels the complex tumor behavior of vestibular schwannoma.
在等待观察管理散发性前庭神经鞘瘤(sporadic vestibular schwannoma)期间，肿瘤自发缩小通常被认为是一种不常见的现象。然而，大多数支持这一认识的数据来自于轴向成像平面中单张线性肿瘤测量。本研究的目的是使用肿瘤体积测量来描述散发性前庭神经鞘瘤的消退能力。
使用切片式、三维体积肿瘤测量的回顾性队列研究。
三个三级转诊中心。
患有散发性前庭神经鞘瘤的患者。
等待观察。
定义为肿瘤体积至少减少 20%的消退率的无复发生存率。
在观察期间共进行了 3505 次磁共振成像检查，952 例患者中有 123 例在诊断后中位时间 1.2 年（四分位距，0.6-2.9 年）出现肿瘤体积消退。诊断后 1、3 和 5 年的体积无复发生存率（95%置信区间；仍处于风险中的人数）分别为 94%（92-95%；662）、86%（83-89%；275）和 78%（73-82%；132）。在 405 例最初表现为肿瘤生长但继续等待观察管理的患者中，48 例在最初生长后中位时间 1.2 年（四分位距，0.8-2.6 年）出现体积消退。最初生长后 1、3 和 5 年的体积无复发生存率分别为 94%（92-97%；260）、84%（79-89%；99）和 75%（67-83%；43）。最终，在最后一次随访时，仅有 82 例患者（952 例研究患者）表现为单纯的肿瘤体积消退（即没有任何肿瘤生长的时期）。
在等待观察管理期间，自发的肿瘤体积缩小比以前使用线性肿瘤测量的研究更常见，甚至可以在以前有记录的肿瘤生长后发生。这些数据进一步强调了前庭神经鞘瘤生长的动态性质。为此，将自然史数据应用于患者管理需要一种细致入微的方法，与前庭神经鞘瘤复杂的肿瘤行为相匹配。
Zotero 插件