The Long-Term Outcomes of Wait-and-Scan and the Role of Radiotherapy in the Management of Vestibular Schwannomas

Abstract

Objective 

To analyze the growth characteristics in patients assigned to wait and scan in vestibular schwannomas (VSs) during long-term follow-up.

Background 

The wait-and-scan policy and radiotherapy (RT) are conservative management strategies for VSs. A better insight into the natural history of the tumor and growth patterns is quintessential in planning optimal management.

Methods 

The charts of 576 patients with unilateral sporadic VSs who were assigned to wait and scan at our center from 1986 to 2013 were reviewed. A systematic review of radiosurgical literature was done and compared with results of wait and scan.

Results 

The overall mean follow-up was 36.9 ± 30.2 months. One hundred fifty-four patients with a 5-year follow-up were analyzed separately for patterns of tumor growth. Varied combinations of growth patterns were observed. Eighty-four (54.5%) tumors showed no growth throughout 5 years, 12 (7.8%) showed slow growth throughout 5 years, 2 (1.3%) tumors showed fast growth throughout 5 years. A total of 134 tumors (87%) showed favorable growth patterns for wait and scan. When the results of wait and scan were compared with those of RT, it pointed to the possibility that at least a portion of control of tumor by RT could be attributed to the natural course of the tumor.

Conclusion 

The wait-and-scan modality is ideal for management of VSs in the elderly population and also in younger patients with intrameatal tumors. Considering the fact that a large percentage of tumors do not require any form of treatment, the role of RT in VSs needs to be reinvestigated.