ANA Discussion Forum
Watch and Wait => For those in the 'watch and wait' status => Topic started by: highlife on January 18, 2009, 10:51:03 pm
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Do any of you know the link to a fairly recent Swedish study that gives statistics of the probability of a small (5mm) tumor not continuing to grow? A couple of docs I talked to mentioned the study, but I think interpreted it a little differently and I'd like to read it myself. Thanks.
Steph
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Sorry have not seen that one (do you have an authors name or journal?) However, this may be of interest
Conservative management of vestibular schwannomas:
third review of a 10-year prospective study
Hajioff, D.,* Raut, V.V.,†Walsh, R.M.,†Bath, A.P.,†Bance, M.L.,†Guha, A., Tator, C.H.
& Rutka, J.A.â€Â
Seventy-two patients with a unilateral vestibular schwannoma have been treated conservatively for a median of 121 months. They have been followed prospectively by serial clinical examination, MRI scans and audiometry.
• Twenty-five patients (35%, 95% CI: 24–47) failed conservative management and required active intervention during the study. No factors predictive of tumour growth or failure of conservative management could be identified. Seventy-five per cent of failures occurred in the first half of the 10-year study.
• The median growth rate for all tumours at 10 years was 1 mm/year (range −0.53–7.84). Cerebellopontine angle tumours grew faster (1.4 mm/year) than intracanalicular tumours (0 mm/year, P < 0.01); 92% had growth rates under 2 mm/year.
• Hearing deteriorated substantially even in tumours that did not grow, but did so faster in tumours that grew significantly (mean deterioration in pure tone average at 0.5, 1, 2 and 3 kHz was 36 dB; speech discrimination scores deteriorated by 40%).
• Patients who failed conservative management had clinical outcomes that were not different from those who underwent primary treatment without a period of conservative management.
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Hi Steph - I don't know the study you are referring to either.
However, the study posted by Esperanza is by a few of the doctors that treat some of the Canadian lot here (Rutka and I think Guha as well). My doctor is in the same practice - and are pretty conservative (like the watch & wait approach for small tumors).
The growth rate you mention for small tumors would be reflective of some of the intracanalicular tumors - i.e. show on average 0mm/year - those littles ones not yet reaching the CPA seem to grow slowly.
If anyone has seen my posts on hearing preservations, this is part of the philosophy that has me curious about the path I will ultimately choose. Waiting, gamma knife and surgery all have relatively speaking poor (and arguable similar) hearing loss rates - just the timeline in which it occurs. (CK appears to have a much better hearing preservation rate as far as I can tell ... but irrelevant because not available in Canada.)
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Thanks for your replies. I have to smile at the 0mm growth of small tumors. How does anyone get to have a large tumor then?
Mine has been growing for at least 10 years, and it is abou 10mm. I like the 0mm better!
Steph
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• Hearing deteriorated substantially even in tumours that did not grow, but did so faster in tumours that grew significantly (mean deterioration in pure tone average at 0.5, 1, 2 and 3 kHz was 36 dB; speech discrimination scores deteriorated by 40%).
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This is true and never fails to amaze me. At least you caught it early and have numerous options available.
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Hi Steph,
Maybe I could ask my doctors about the study when I see them again on 2nd of March. I think they know about it since I'm from Sweden and I'm also going to get my surgery here in Sweden.
Best regards,
Helene :)
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Helene:
Good luck! One of my fears about W & W was that the AN would hit the CP angle a grow like mad. My is apparently just on the verge of going beyond the inner ear canal. Let me know what you find out.
I'm scheduled for surgery March 4. It's coming right up.
Steph
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Personally I think tumor growth and age are very important in coming to th best course of action. Lets say your 40 with a 10mm tumor. I would honestly think according to treatment procedures while being a small tumor and now having such good results to remove it conserving your hearing may be the way to go. AT 60 with the same 10 mm tumor with close monitoring and a much more chance of slower to no growth W+W would look like a better option. At 50 I would say your on the boader line. In any case just my way of thinking after close to 2 years of research. In all cases monitoring is most important and let your tumor and symptoms be your guide. Good Luck, Mickey