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Inicio Acta Otorrinolaringológica Española Non surgical Treatment of Vestibular Schwannoma
Journal Information
Vol. 66. Issue 4.
Pages 185-191 (July - August 2015)
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Vol. 66. Issue 4.
Pages 185-191 (July - August 2015)
Original article
Non surgical Treatment of Vestibular Schwannoma
Tratamiento no quirúrgico del schwannoma vestibular
Visits
3334
Leoncio Arribasa,f,
Corresponding author
larribas@fivo.org

Corresponding author.
, María L. Chusta, Antonio Menéndezb, Estanislao Aranac, Juan B. Vendrelld, Vicente Crispíne, Carmen Pesudoa, José L. Menguala, Alejandro Muta, Mar Arribasg, José L. Guinota
a Servicio de Oncología Radioterápica, Hospital Fundación IVO, Valencia, Spain
b Servicio de Neurocirugía, Hospital Universitario La Fe, Valencia, Spain
c Servicio de Radiología, Hospital Fundación IVO, Valencia, Spain
d Servicio de ORL, Hospital Fundación IVO, Valencia, Spain
e Servicio de Radiofísica, Hospital Fundación IVO, Valencia, Spain
f Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
g Servicio de ORL, Hospital General de Valencia, Valencia, Spain
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Tables (4)
Table 1. Koos Classification of Vestibular Schwannomas.
Table 2. Treatment Carried Out.
Table 3. Base Patient Characteristics.
Table 4. Recurrence According to Tumour Size (Koos Classification).
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Abstract
Introduction and objectives

To evaluate the results of local control and complications in the treatment of vestibular schwannoma treated with radiation.

Methods

A retrospective study of 194 patients diagnosed with vestibular schwannoma, treated consecutively with radiation (either stereotactic radiosurgery or fractionated radiotherapy) from 1997 to 2012. We analyse the local control of tumours, as well as secondary complications to treatment with radiation.

Results

A total of 132 (68%) tumours, 68% are grade III tumours of the Koos classification, 40 (19%) are grade III, and 22 (13%) are grade IV. The tumours associated with neurofibromatosis (NF2) are 3.6% (6 tumours in 4 patients). The tumour control for the overall series is 97% at 5 years, with a median follow-up of 80.4 months. For large tumours the local control is 91% at 5 years. Free survival of chronic complications is 89% at 5 years. Additionally, 50 tumours were subjected to regular follow-up with MRI without treatment, and 28 (58%) did not experience tumour growth.

Conclusions

Radiation and follow-up with MRI are alternatives to surgery in the treatment of vestibular schwannoma, with a low level of complications in a multidisciplinary approach.

Keywords:
Vestibular schwannoma
Acoustic neuroma
Radiosurgery
Fractionated stereotactic radiotherapy
Observation
Resumen
Introducción y objetivos

Valorar los resultados de control local y complicaciones en el tratamiento del schwannoma vestibular tratado con radiaciones.

Métodos

Estudio retrospectivo de 194 pacientes diagnosticados de schwannoma vestibular, tratados de manera consecutiva bien con observación o bien con radiaciones (bien radiocirugía o radioterapia esterotáctica fraccionada) de 1997 a 2012. Analizamos el control local de los tumores, así como de las complicaciones secundarias al tratamiento con radiocirugía.

Resultados

El 68% (132 tumores) son inferiores a 2cm es decir grado I-II de la clasificación de Koos, 22 pacientes (13%) con tumores grandes grado IV, el resto (40 pacientes) son grado III. Los tumores relacionados con la neurofibromatosis (NF2) representan el 3,6% (6 tumores en 4 pacientes). El control tumoral para los pacientes tratados con radiaciones es del 97% a 5 años, con un seguimiento mediano de 80,4 meses. Para los tumores grandes el control local es del 91% a 5 años. La supervivencia libre de complicaciones crónicas es del 89% a 5 años. De los 50 tumores a los que se realizó seguimiento, 28 (58%) continúan en seguimiento al no haberse objetivado crecimiento alguno.

Conclusiones

La radiación y el seguimiento con RM, dentro de un enfoque multidisciplinar, es una alternativa a la cirugía en el tratamiento del schwannoma vestibular, con un bajo nivel de complicaciones.

Palabras clave:
Schwannoma vestibular
Neurinoma acústico
Radiocirugía
Radioterapia estereotáctica fraccionada
Observación

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