Document Detail


Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life.
MedLine Citation:
PMID:  23615094     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124).
OBJECTIVE: The aim was to measure the effect of GKRS compared with the natural course on tumor growth rate and hearing loss. Secondary end points were postinclusion additional treatment, quality of life (QoL), and symptom development.
METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QoL assessment by SF-36 questionnaire. Statistics were performed by using Spearman correlation coefficient, Kaplan-Meier plot, Poisson regression model, mixed linear regression models, and mixed logistic regression models.
RESULTS: Mean follow-up time was 55.0 months (26.1 standard deviation, range 10-132). Thirteen patients were lost to follow-up. Serviceable hearing was lost in 54 of 71 (76%) (CM) and 34 of 53 (64%) (GKRS) patients during the study period (not significant, log-rank test). There was a significant reduction in tumor volume over time in the GKRS group. The need for treatment following initial GKRS or CM differed at highly significant levels (log-rank test, P < .001). Symptom and QoL development did not differ significantly between the groups.
CONCLUSION: In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.
Authors:
Cathrine Nansdal Breivik; Roy Miodini Nilsen; Erling Myrseth; Paal Henning Pedersen; Jobin K Varughese; Aqeel Asghar Chaudhry; Morten Lund-Johansen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Neurosurgery     Volume:  73     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-20     Completed Date:  2014-01-24     Revised Date:  2014-02-05    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  48-56; discussion 56-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antineoplastic Agents / therapeutic use*
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local / epidemiology*,  prevention & control*
Neuroma, Acoustic / epidemiology*,  therapy*
Norway / epidemiology
Quality of Life*
Radiosurgery / utilization*
Treatment Outcome
Tumor Burden
Chemical
Reg. No./Substance:
0/Antineoplastic Agents
Comments/Corrections
Comment In:
Neurosurgery. 2014 Jan;74(1):E144-5   [PMID:  24030176 ]
Neurosurgery. 2014 Jan;74(1):E144   [PMID:  24362241 ]

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