Acoustic neuroma medical therapy: Difference between revisions
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{{CMG}}{{AE}}{{Simrat}} {{M.B}} | {{CMG}}{{AE}}{{Simrat}} {{M.B}} | ||
== Overview== | == Overview== | ||
The mainstay of therapy for acoustic neuroma is [[surgery]] and [[radiation therapy]]. Since acoustic neuroma tends to be slow-growing and is [[benign]] tumor, careful observation with follow-up [[Magnetic resonance imaging|MRI scans]] every 6 to 12 months may be appropriate for elderly patients | The mainstay of [[therapy]] for acoustic neuroma is [[surgery]] and [[radiation therapy]]. Since acoustic neuroma tends to be slow-growing and is a [[benign]] tumor, careful observation with follow-up [[Magnetic resonance imaging|MRI scans]] every 6 to 12 months may be appropriate for elderly [[Patient|patients]], [[Patient|patients]] with small [[Tumor|tumors]], [[Patient|patients]] with significant [[medical conditions]], and [[Patient|patients]] who refuse treatment. | ||
==Medical Therapy== | ==Medical Therapy== | ||
The mainstay of therapy for acoustic neuroma is [[surgery]] and [[radiation therapy]]. Since acoustic neuroma tends to be slow-growing and is [[benign]] tumor, careful observation with follow-up [[Magnetic resonance imaging|MRI scans]] every 6 to 12 months may be appropriate among following groups of patients:<ref>{{Cite journal | The mainstay of [[therapy]] for acoustic neuroma is [[surgery]] and [[radiation therapy]]. Since acoustic neuroma tends to be slow-growing and is a [[benign]] tumor, careful observation with follow-up [[Magnetic resonance imaging|MRI scans]] every 6 to 12 months may be appropriate among the following groups of [[Patient|patients]]:<ref>{{Cite journal | ||
| author = [[Wissame El Bakkouri]], [[Romain E. Kania]], [[Jean-Pierre Guichard]], [[Guillaume Lot]], [[Philippe Herman]] & [[Patrice Tran Ba Huy]] | | author = [[Wissame El Bakkouri]], [[Romain E. Kania]], [[Jean-Pierre Guichard]], [[Guillaume Lot]], [[Philippe Herman]] & [[Patrice Tran Ba Huy]] | ||
| title = Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment | | title = Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment | ||
| Line 29: | Line 29: | ||
| pmid = 15744156 | | pmid = 15744156 | ||
}}</ref> | }}</ref> | ||
*Patients with a tumor in their only [[hearing]] or better hearing ear | *[[Patients]] with a [[tumor]] in their only [[hearing]] or better [[Hearing (sense)|hearing]] [[ear]] | ||
*When the tumor is of a size that hearing preservation with treatment would be unlikely | *When the [[tumor]] is of a size that hearing preservation with treatment would be unlikely | ||
*Elderly patients | *Elderly [[Patient|patients]] | ||
*Small tumors in older individuals that do not grow | *Small [[Tumor|tumors]] in older individuals that do not grow | ||
*Patients with small tumors with good hearing | *[[Patient|Patients]] with small [[Tumor|tumors]] with good [[Hearing (sense)|hearing]] | ||
*Patients with medical conditions that increase the risk of [[surgery]] | *[[Patient|Patients]] with [[medical conditions]] that increase the risk of [[Complication (medicine)|complications]] of [[surgery]] | ||
*Patients who refuse treatment | *[[Patient|Patients]] who refuse treatment | ||
*Patients with a [[tumor]] on the side of an only hearing ear or only seeing [[eye]] | *[[Patient|Patients]] with a [[tumor]] on the side of an only [[Hearing (sense)|hearing]] [[ear]] or only [[Sight|seeing]] [[eye]] | ||
===Observation=== | ===Observation=== | ||
The strategies for patient observation include: | The strategies for [[patient]] [[observation]] include: | ||
* Assessment of [[facial nerve]] function, [[hearing]], [[tinnitus]] and [[ataxia]]. | * Assessment of [[facial nerve]] function, [[hearing]], [[tinnitus]], and [[ataxia]]. | ||
* An [[MRI]] is performed every 6 months or yearly depending on the rate of [[tumor]] growth. | * An [[MRI]] is performed every 6 months or yearly depending on the rate of [[tumor]] growth. | ||
* The average growth rate of tumor is 1.15 to 2.4 mm per year. If the tumor grows or causes serious symptoms, treatment is suggested. If the scans show | * The average growth rate of [[tumor]] is 1.15 to 2.4 mm per year. If the [[tumor]] grows or causes serious [[Symptom|symptoms]], treatment is suggested. If the scans show [[tumor]] growth or if the [[tumor]] causes progressive [[Symptom|symptoms]] or other difficulties, considering [[Surgery|surgical intervention]] is mandatory. <ref>{{Cite journal|last=Wissame el Bakkouri, M.D., romain e. kania, M.D., Ph.D., Jean-Pierre Guichard, M.D., Guillaume lot, M.D., Philippe herman, M.D., Ph.D., and Patrice tran Ba huy, M.D.|first=|date=2007|title=Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment|url=|journal=J Neurosurg|volume=11|pages=662|via=}}</ref> | ||
===Radiation Therapy=== | ===Radiation Therapy=== | ||
[[Radiation therapy]] approaches that have been used in [[Patient|patients]] with acoustic neuroma include: | |||
* [[Stereotactic surgery|Stereotactic radiosurgery]] | * [[Stereotactic surgery|Stereotactic radiosurgery]] | ||
* Stereotactic radiotherapy | * Stereotactic [[Radiation therapy|radiotherapy]] | ||
* Proton beam therapy | * Proton beam [[therapy]] | ||
==== Stereotactic | ==== Stereotactic Radiosurgery ==== | ||
[[Stereotactic surgery|Stereotactic radiosurgery | [[Stereotactic surgery|Stereotactic radiosurgery (SRS)]], is a treatment option for [[Patient|patients]] with [[Tumor|tumors]] smaller than 3 cm or for enlarging [[Tumor|tumors]] in [[patients]] with significant [[medical conditions]] and are not candidates for [[surgery]]. It delivers multiple precisely-targeted radiation convergent beams to minimize [[injury]] to adjacent structures. This can be accomplished with either the [[Gamma Knife|gamma knife]] or a [[Linear particle accelerator|linear accelerator]].<ref>{{Cite journal | ||
| author = [[Marianna Karpinos]], [[Bin S. Teh]], [[Otto Zeck]], [[L. Steven Carpenter]], [[Chris Phan]], [[Wei-Yuan Mai]], [[Hsin H. Lu]], [[J. Kam Chiu]], [[E. Brian Butler]], [[William B. Gormley]] & [[Shiao Y. Woo]] | | author = [[Marianna Karpinos]], [[Bin S. Teh]], [[Otto Zeck]], [[L. Steven Carpenter]], [[Chris Phan]], [[Wei-Yuan Mai]], [[Hsin H. Lu]], [[J. Kam Chiu]], [[E. Brian Butler]], [[William B. Gormley]] & [[Shiao Y. Woo]] | ||
| title = Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery | | title = Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery | ||
| Line 74: | Line 74: | ||
====Stereotactic radiotherapy==== | ====Stereotactic radiotherapy==== | ||
Stereotactic radiotherapy (SRT) | * Stereotactic [[Radiation therapy|radiotherapy]] (SRT) and fractionated stereotactic [[Radiation therapy|radiotherapy]] deliver smaller [[Dose|doses]] of [[Radiation therapy|radiation]] over a period of time, requiring the [[patient]] to return to the treatment location on a daily basis, from 3 to 30 times, generally over several weeks. | ||
* Each visit lasts a few minutes and most [[Patient|patients]] are free to go about their daily business before and after each treatment session. | |||
* Early [[data]] indicates that SRT may result in better [[Hearing (sense)|hearing]] preservation when compared to single-session SRS.<ref>{{Cite journal | |||
| author = [[Marianna Karpinos]], [[Bin S. Teh]], [[Otto Zeck]], [[L. Steven Carpenter]], [[Chris Phan]], [[Wei-Yuan Mai]], [[Hsin H. Lu]], [[J. Kam Chiu]], [[E. Brian Butler]], [[William B. Gormley]] & [[Shiao Y. Woo]] | | author = [[Marianna Karpinos]], [[Bin S. Teh]], [[Otto Zeck]], [[L. Steven Carpenter]], [[Chris Phan]], [[Wei-Yuan Mai]], [[Hsin H. Lu]], [[J. Kam Chiu]], [[E. Brian Butler]], [[William B. Gormley]] & [[Shiao Y. Woo]] | ||
| title = Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery | | title = Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery | ||
| Line 87: | Line 90: | ||
====Proton beam therapy==== | ====Proton beam therapy==== | ||
*The use of [[proton]] beam therapy permits the delivery of high doses of | *The use of [[proton]] beam [[therapy]] permits the delivery of high [[Dose|doses]] of [[Radiation therapy|radiation]] to the target volume while limiting the dose received by surrounding [[Tissue (biology)|tissues]]. It provides maximum local [[tumor]] control with minimum [[cranial nerve]] injuries.<ref>{{Cite journal | ||
| author = [[W. P. Levin]], [[H. Kooy]], [[J. S. Loeffler]] & [[T. F. DeLaney]] | | author = [[W. P. Levin]], [[H. Kooy]], [[J. S. Loeffler]] & [[T. F. DeLaney]] | ||
| title = Proton beam therapy | | title = Proton beam therapy | ||
| Line 99: | Line 102: | ||
| pmid = 16189526 | | pmid = 16189526 | ||
}}</ref> | }}</ref> | ||
*In comparison with conventional radiation therapy | *In comparison with conventional [[radiation therapy]] where [[electromagnetic waves]] in [[x-rays]] pass through target and adjacent [[Tissue (biology)|tissues]], in [[proton]] beam [[therapy]], [[energy]] is carried by [[proton]] beams and the majority of the [[energy]] being deposited within the target. | ||
*It provides excellent local control of acoustic neuromas with acceptable preservation of [[Hearing (sense)|hearing]] and [[Facial nerve|facial]] and [[trigeminal nerve]] function.<ref>{{Cite journal | |||
| author = [[David A. Bush]], [[Calvin J. McAllister]], [[Lilia N. Loredo]], [[Walter D. Johnson]], [[James M. Slater]] & [[Jerry D. Slater]] | | author = [[David A. Bush]], [[Calvin J. McAllister]], [[Lilia N. Loredo]], [[Walter D. Johnson]], [[James M. Slater]] & [[Jerry D. Slater]] | ||
| title = Fractionated proton beam radiotherapy for acoustic neuroma | | title = Fractionated proton beam radiotherapy for acoustic neuroma | ||
Latest revision as of 19:17, 26 April 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohsen Basiri M.D.
Overview
The mainstay of therapy for acoustic neuroma is surgery and radiation therapy. Since acoustic neuroma tends to be slow-growing and is a benign tumor, careful observation with follow-up MRI scans every 6 to 12 months may be appropriate for elderly patients, patients with small tumors, patients with significant medical conditions, and patients who refuse treatment.
Medical Therapy
The mainstay of therapy for acoustic neuroma is surgery and radiation therapy. Since acoustic neuroma tends to be slow-growing and is a benign tumor, careful observation with follow-up MRI scans every 6 to 12 months may be appropriate among the following groups of patients:[1][2]
- Patients with a tumor in their only hearing or better hearing ear
- When the tumor is of a size that hearing preservation with treatment would be unlikely
- Elderly patients
- Small tumors in older individuals that do not grow
- Patients with small tumors with good hearing
- Patients with medical conditions that increase the risk of complications of surgery
- Patients who refuse treatment
- Patients with a tumor on the side of an only hearing ear or only seeing eye
Observation
The strategies for patient observation include:
- Assessment of facial nerve function, hearing, tinnitus, and ataxia.
- An MRI is performed every 6 months or yearly depending on the rate of tumor growth.
- The average growth rate of tumor is 1.15 to 2.4 mm per year. If the tumor grows or causes serious symptoms, treatment is suggested. If the scans show tumor growth or if the tumor causes progressive symptoms or other difficulties, considering surgical intervention is mandatory. [3]
Radiation Therapy
Radiation therapy approaches that have been used in patients with acoustic neuroma include:
- Stereotactic radiosurgery
- Stereotactic radiotherapy
- Proton beam therapy
Stereotactic Radiosurgery
Stereotactic radiosurgery (SRS), is a treatment option for patients with tumors smaller than 3 cm or for enlarging tumors in patients with significant medical conditions and are not candidates for surgery. It delivers multiple precisely-targeted radiation convergent beams to minimize injury to adjacent structures. This can be accomplished with either the gamma knife or a linear accelerator.[4][5]
Stereotactic radiotherapy
- Stereotactic radiotherapy (SRT) and fractionated stereotactic radiotherapy deliver smaller doses of radiation over a period of time, requiring the patient to return to the treatment location on a daily basis, from 3 to 30 times, generally over several weeks.
- Each visit lasts a few minutes and most patients are free to go about their daily business before and after each treatment session.
- Early data indicates that SRT may result in better hearing preservation when compared to single-session SRS.[6]
Proton beam therapy
- The use of proton beam therapy permits the delivery of high doses of radiation to the target volume while limiting the dose received by surrounding tissues. It provides maximum local tumor control with minimum cranial nerve injuries.[7]
- In comparison with conventional radiation therapy where electromagnetic waves in x-rays pass through target and adjacent tissues, in proton beam therapy, energy is carried by proton beams and the majority of the energy being deposited within the target.
- It provides excellent local control of acoustic neuromas with acceptable preservation of hearing and facial and trigeminal nerve function.[8]
References
- ↑ Wissame El Bakkouri, Romain E. Kania, Jean-Pierre Guichard, Guillaume Lot, Philippe Herman & Patrice Tran Ba Huy (2009). "Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment". Journal of neurosurgery. 110 (4): 662–669. doi:10.3171/2007.5.16836. PMID 19099381. Unknown parameter
|month=ignored (help) - ↑ Eric E. Smouha, Michael Yoo, Kristi Mohr & Raphael P. Davis (2005). "Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm". The Laryngoscope. 115 (3): 450–454. doi:10.1097/01.mlg.0000175681.52517.cf. PMID 15744156. Unknown parameter
|month=ignored (help) - ↑ Wissame el Bakkouri, M.D., romain e. kania, M.D., Ph.D., Jean-Pierre Guichard, M.D., Guillaume lot, M.D., Philippe herman, M.D., Ph.D., and Patrice tran Ba huy, M.D. (2007). "Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment". J Neurosurg. 11: 662.
- ↑ Marianna Karpinos, Bin S. Teh, Otto Zeck, L. Steven Carpenter, Chris Phan, Wei-Yuan Mai, Hsin H. Lu, J. Kam Chiu, E. Brian Butler, William B. Gormley & Shiao Y. Woo (2002). "Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery". International journal of radiation oncology, biology, physics. 54 (5): 1410–1421. PMID 12459364. Unknown parameter
|month=ignored (help) - ↑ Joseph C. T. Chen & Michael R. Girvigian (2005). "Stereotactic radiosurgery: instrumentation and theoretical aspects-part 1". The Permanente journal. 9 (4): 23–26. PMID 22811641. Unknown parameter
|month=ignored (help) - ↑ Marianna Karpinos, Bin S. Teh, Otto Zeck, L. Steven Carpenter, Chris Phan, Wei-Yuan Mai, Hsin H. Lu, J. Kam Chiu, E. Brian Butler, William B. Gormley & Shiao Y. Woo (2002). "Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery". International journal of radiation oncology, biology, physics. 54 (5): 1410–1421. PMID 12459364. Unknown parameter
|month=ignored (help) - ↑ W. P. Levin, H. Kooy, J. S. Loeffler & T. F. DeLaney (2005). "Proton beam therapy". British journal of cancer. 93 (8): 849–854. doi:10.1038/sj.bjc.6602754. PMID 16189526. Unknown parameter
|month=ignored (help) - ↑ David A. Bush, Calvin J. McAllister, Lilia N. Loredo, Walter D. Johnson, James M. Slater & Jerry D. Slater (2002). "Fractionated proton beam radiotherapy for acoustic neuroma". Neurosurgery. 50 (2): 270–273. PMID 11844261. Unknown parameter
|month=ignored (help)