Acoustic neuroma medical therapy: Difference between revisions

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__NOTOC__
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{{Acoustic neuroma}}
{{Acoustic neuroma}}
{{CMG}}
{{CMG}}{{AE}}{{Simrat}} {{M.B}}
== Overview==
== Overview==
Because these neuromata grow so slowly, a physician may opt for conservative treatment beginning with an observation period. In such a case, the tumor is monitored by annual [[MRI]] to monitor growth. Records suggest that about 45% of acoustic neuromata do not grow detectably over the 3-5 years of observation. In rare cases, acoustical neuromata have been known to shrink spontaneously. Often people with acoustic neuromata [[death|die]] of other causes before the neuroma becomes life-threatening. (This is especially true of [[old age|elderly]] people possessing a small neuroma.)
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==
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]]
| title = Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment
| journal = [[Journal of neurosurgery]]
| volume = 110
| issue = 4
| pages = 662–669
| year = 2009
| month = April
| doi = 10.3171/2007.5.16836
| pmid = 19099381
}}</ref><ref>{{Cite journal
| author = [[Eric E. Smouha]], [[Michael Yoo]], [[Kristi Mohr]] & [[Raphael P. Davis]]
| title = Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm
| journal = [[The Laryngoscope]]
| volume = 115
| issue = 3
| pages = 450–454
| year = 2005
| month = March
| doi = 10.1097/01.mlg.0000175681.52517.cf
| pmid = 15744156
}}</ref>
*[[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
*Elderly [[Patient|patients]]
*Small [[Tumor|tumors]] in older individuals that do not grow
*[[Patient|Patients]] with small [[Tumor|tumors]] with good [[Hearing (sense)|hearing]]
*[[Patient|Patients]] with [[medical conditions]] that increase the risk of [[Complication (medicine)|complications]] of [[surgery]]
*[[Patient|Patients]] who refuse treatment
*[[Patient|Patients]] with a [[tumor]] on the side of an only [[Hearing (sense)|hearing]] [[ear]] or only [[Sight|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 [[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]] approaches that have been used in [[Patient|patients]] with acoustic neuroma include:
* [[Stereotactic surgery|Stereotactic radiosurgery]]
* Stereotactic [[Radiation therapy|radiotherapy]]
* Proton beam [[therapy]]
 
==== 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]]
| title = Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery
| journal = [[International journal of radiation oncology, biology, physics]]
| volume = 54
| issue = 5
| pages = 1410–1421
| year = 2002
| month = December
| pmid = 12459364
}}</ref><ref>{{Cite journal
| author = [[Joseph C. T. Chen]] & [[Michael R. Girvigian]]
| title = Stereotactic radiosurgery: instrumentation and theoretical aspects-part 1
| journal = [[The Permanente journal]]
| volume = 9
| issue = 4
| pages = 23–26
| year = 2005
| month = Fall
| pmid = 22811641
}}</ref>


Since the growth rate of an acoustic neuroma rarely accelerates, annual observation is sufficient. Acoustic neuromata may cause either gradual or&mdash;less commonly&mdash;sudden [[hearing impairment|hearing loss]] and [[tinnitus]].
====Stereotactic radiotherapy====
* 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.  


==Medical Therapy==
* 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]]
| title = Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery
| journal = [[International journal of radiation oncology, biology, physics]]
| volume = 54
| issue = 5
| pages = 1410–1421
| year = 2002
| month = December
| pmid = 12459364
}}</ref>


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====Proton beam therapy====
*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]]
  | title = Proton beam therapy
  | journal = [[British journal of cancer]]
| volume = 93
| issue = 8
| pages = 849–854
| year = 2005
| month = October
| doi = 10.1038/sj.bjc.6602754
| pmid = 16189526
}}</ref>
*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]]
| title = Fractionated proton beam radiotherapy for acoustic neuroma
| journal = [[Neurosurgery]]
| volume = 50
| issue = 2
| pages = 270–273
| year = 2002
| month = February
| pmid = 11844261
}}</ref>


==References==
==References==
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[[Category:Types of cancer]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Otolaryngology]]
[[Category:Neurology]]
[[Category:Neurosurgery]]

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]

Observation

The strategies for patient observation include:

Radiation Therapy

Radiation therapy approaches that have been used in patients with acoustic neuroma include:

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

References

  1. ↑ 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)
  2. ↑ 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)
  3. ↑ 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.
  4. ↑ 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)
  5. ↑ 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)
  6. ↑ 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)
  7. ↑ 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)
  8. ↑ 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)

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