The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes

2010 ◽  
Vol 112 (1) ◽  
pp. 163-167 ◽  
Author(s):  
Michael E. Sughrue ◽  
Isaac Yang ◽  
Derick Aranda ◽  
Khadja Lobo ◽  
Lawrence H. Pitts ◽  
...  
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Growth ◽  
Tumor Size ◽  
Management Options ◽  
Hearing Outcome ◽  
Initial Tumor ◽  
History Of ◽  
Initial Tumor Size

Object Observation is an important consideration when discussing management options for patients with vestibular schwannoma (VS). Most data regarding clinical outcomes after conservative management come from modestsized series performed at individual centers. The authors performed an analysis of the published literature on the natural history of VSs with respect to hearing outcome. Their objective was to provide a comprehensive and unbiased description of outcomes in patients whose disease was managed conservatively. Methods The authors identified a total of 34 published studies containing hearing outcome data in patients with VSs < 25 mm in largest diameter who underwent observation management. The effects of initial tumor size and tumor growth rate on hearing function at latest follow-up were analyzed. Data from individual and aggregated cases were extracted from each study. Patients with poorer hearing (American Association of Otolaryngology–Head and Neck Surgery Classes C or D, or Gardner-Robertson Classes III, IV, or V) at the time of presentation were excluded. Results A total of 982 patients met the inclusion criteria for this analysis, with a mean initial tumor size of 11.3 ± 0.68 mm. The mean growth rate was 2.9 ± 1.2 mm/year. The length of follow-up for these studies ranged from 26 to 52 months. Patients with preserved hearing at latest follow-up had a statistically larger initial tumor size than those whose hearing declined during the observation period (11.5 ± 2.3 mm vs 9.3 ± 2.7 mm, p < 0.0001), but the 2-mm difference of means was at the limit of imaging resolution and observer reliability. In contrast, patients with lower rates of tumor growth (≤ 2.5 mm/year) had markedly higher rates of hearing preservation (75 vs 32%, p < 0.0001) compared with patients with higher tumor growth rates. Interestingly, the authors' analysis found no difference in the rate of reported intervention for patients in either group (16 vs 18%, p = not significant). Conclusions These data suggest that a growth rate of > 2.5 mm/year is a better predictor of hearing loss than the initial tumor size for patients undergoing observation management of VSs < 25 mm in largest diameter.

The Natural History of Incidental Meningiomas

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Julia Michel ◽  
Cornelius Jacobs ◽  
Madjid Samii
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Growth ◽  
Growth Rates ◽  
Tumor Size ◽  
Annual Growth ◽  
Tumor Doubling Time ◽  
History Of ◽  
Doubling Times ◽  
Initial Tumor Size

Abstract OBJECTIVE Little information about the natural history of incidental meningiomas exists in the literature. The aim of this study was to determine the natural history of asymptomatic meningiomas by comparing different methods of growth rate calculation to establish a strategy for dealing with these tumors. METHODS In 47 asymptomatic patients, hospital charts, follow-up records, and imaging studies were reviewed. Of these patients, 6 underwent surgery. Tumor growth rates were determined by calculating the absolute and relative growth rates and the tumor volume doubling times. RESULTS In 41 patients with conservative management, the average tumor size was 9 cm3, and the majority (66%) of growth rates were less than 1 cm3/yr. The absolute growth rate ranged from 0.03 to 2.62 cm3/yr (mean, 0.796 cm3/yr). Relative annual growth rates ranged from 0.48 to 72.8% (mean, 14.6%). The tumor doubling time ranged from 1.27 to 143.5 years (mean, 21.6 yr). A moderate correlation between the age and growth rates was found. In young patients, annual growth rates tended to be higher and tumor doubling times shorter. There was no clear correlation between the initial tumor size and tumor doubling time. The mean annual growth rate of meningiomas with calcification was lower than in tumors without calcification. Also, tumors with hypointense or isointense T2 signals on magnetic resonance imaging had a lower growth rate. In the group of six patients with surgical excision, tumor growth rates were higher and tumor doubling times shorter than in the nonsurgical group. CONCLUSION The majority of incidental meningiomas show minimal growth; thus, they may be observed without surgical intervention unless specific symptoms appear. Tumor growth is associated with patient age. The initial tumor size is not considered a predictive factor for tumor growth. Radiological features, such as calcification or T2 signal intensity, may provide useful information to predict the growth potential of meningiomas.

A prospective study of hearing preservation in untreated vestibular schwannomas

2011 ◽  
Vol 114 (2) ◽  
pp. 381-385 ◽  
Author(s):  
Michael E. Sughrue ◽  
Ari J. Kane ◽  
Rajwant Kaur ◽  
Jeffrey J. Barry ◽  
Martin J. Rutkowski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Growth Rate ◽  
Hearing Loss ◽  
Tumor Growth ◽  
Median Time ◽  
Tumor Size ◽  
Vestibular Schwannomas ◽  
Tumor Growth Rate ◽  
Initial Tumor ◽  
Initial Tumor Size

Object The authors previously published a systematic review of the English language literature regarding the natural history of untreated vestibular schwannomas (VSs). This analysis found that the best predictor of future hearing loss was tumor growth > 2.5 mm/year on serial imaging, a factor that doubled the rate of hearing loss. In this paper the authors present an analysis of prospectively collected outcomes in patients with untreated VS from their institution that confirms their previous findings. Methods Clinical, radiographic, and audiometric data for all patients evaluated for VS at the authors' institution over a 22-year period were prospectively collected in a database. All patients in this database who had serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery Grade A or B) on initial presentation were selected, and underwent serial observation. Magnetic resonance imaging and audiometric data were analyzed, and the time from presentation until hearing loss was analyzed using Kaplan-Meier analysis. Results Fifty-nine patients with VS who initially presented with serviceable hearing were treated conservatively over this period. Consistent with the authors' previous findings, patients with a tumor growth rate > 2.5 mm/year at any point during follow-up lost their hearing at a much faster rate than those who had slower growing tumors. The median time to hearing loss was 7.0 years in those patients with tumor growth rate > 2.5 mm/year compared to 14.8 years in the other patients (p < 0.0001). The estimated median time to hearing loss in the 3 initial tumor size groups was 11.6 years in the intracanalicular group, 10.3 years in the group with 0.1–1 cm extension into the CPA cistern, and 9.3 years in the group with > 1 cm extension into the CPA cistern (p value nonsignificant). Initial tumor size, age at diagnosis, and neurofibromatosis Type 2 status did not affect the time to loss of serviceable hearing. Interestingly, many patients who were followed up for more than a decade eventually lost their hearing, regardless of whether the tumor displayed any documented interval growth. Conclusion The authors confirmed the findings of their systematic review of the literature using a prospectively followed group of patients with untreated VS. Collectively, these data suggest that the expectation for more rapid hearing loss should be communicated to patients, and the decision for surgical or other intervention should be made in the context of the known risk of continued observation of fast growing tumors.

scholarly journals Developing an optimal follow-up strategy based on the natural history of nonfunctioning pituitary adenomas

2019 ◽  
Vol 131 (2) ◽  
pp. 500-506 ◽  
Author(s):  
Jung Hee Kim ◽  
Yun-Sik Dho ◽  
Yong Hwy Kim ◽  
Jung Hyun Lee ◽  
Ji Hyun Lee ◽  
...  
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Growth ◽  
Visual Function ◽  
Pituitary Adenomas ◽  
Tumor Volume ◽  
Volume Growth ◽  
Tumor Growth Rate ◽  
Mri Study

OBJECTIVEThe natural history and proper algorithm for follow-up testing of nonfunctioning pituitary adenomas (PAs) are not well known, despite their relatively high prevalence. The aim of this study was to suggest the optimal follow-up algorithm for nonfunctioning PAs based on their natural history.METHODSThe authors followed up 197 patients with nonfunctioning PAs that had not been treated (including surgery and radiation therapy) at the time of detection, in a single center, between March 2000 and February 2017. They conducted a hormone test, visual field test, and MRI at the time of diagnosis and yearly thereafter.RESULTSThe overall median follow-up duration was 37 months. Microadenomas (n = 38) did not cause visual disturbance, pituitary apoplexy, or endocrine dysfunction. The incidence of patients with tumor volume growth ≥ 20% was higher for macroadenomas than microadenomas (13.8 vs 5.0 per 100 person-years [PYs], p = 0.002). The median time to any tumor growth was 4.8 years (95% CI 3.4–4.8 years) for microadenomas and 4 years (95% CI 3.3–4.2 years) for macroadenomas. The overall incidence of worsening visual function was 0.69 per 100 PYs. Patients with a tumor volume growth rate ≥ 0.88 cm3/year (n = 20) had a higher incidence of worsening visual function (4.69 vs 0.30 per 100 PYs, p < 0.001). The tumor growth rate of all microadenomas was < 0.88 cm3/year. The median time to tumor growth ≥ 20% was 3.3 years (95% CI 1.8–3.9 years) in patients with a tumor growth rate ≥ 0.88 cm3/year and 4.9 years (95% CI 4.6–7.2 years) in patients with a tumor growth rate < 0.88 cm3/year.CONCLUSIONSThe authors have devised a follow-up strategy based on the tumor volume growth rate as well as initial tumor volume. In patients with microadenomas, the next MRI study can be performed at 3 years. In patients with macroadenomas, the second MRI study should be performed between 6 months and 1 year to assess the tumor growth rate. In patients with a tumor growth rate ≥ 0.88 cm3/year, the MRI study should be performed within 2 years. In patients with a tumor growth rate < 0.88 cm3/year, the MRI study can be delayed until 4 years.

The natural history of intracranial meningiomas

2011 ◽  
Vol 114 (5) ◽  
pp. 1250-1256 ◽  
Author(s):  
Soichi Oya ◽  
Seon-Hwan Kim ◽  
Burak Sade ◽  
Joung H. Lee
Keyword(s):  
Natural History ◽  
Mr Imaging ◽  
Tumor Growth ◽  
Maximum Diameter ◽  
Tumor Diameter ◽  
Annual Growth Rate ◽  
Volumetric Growth ◽  
Factors Associated ◽  
Initial Tumor

Object Despite the increased detection of incidental or small meningiomas, the lesion's natural history is largely unknown. Methods One year or longer of follow-up was conducted in 244 patients with 273 meningiomas managed conservatively by a single surgeon between 2003 and 2008. Data were stratified according to age, sex, tumor location, symptoms, initial tumor diameter, calcification, MR imaging intensity, and edema. Linear tumor growth was defined as a 2-mm or larger increase in the maximum diameter in any direction of the tumor. Volumetric analysis (ImageJ version 1.43) was also conducted in 154 of 273 meningiomas for which complete radiological data were available in the form of DICOM files throughout the follow-up period. A volume increase greater than 8.2% was regarded as significant because the preliminary volumetry based on 20 randomly selected meningiomas showed that the average SD was 4.1%. Results Linear growth was observed in 120 tumors (44.0%) with a mean follow-up of 3.8 years. Factors related to tumor growth were age of 60 or younger (p = 0.0004), absence of calcification (p = 0.027), MR imaging T2 signal hyperintensity (p = 0.021), and edema (p = 0.018). Kaplan-Meier analysis and Cox proportional hazards regression analysis revealed that age 60 or younger (hazard ratio [HR] 1.54, 95% CI 1.05–2.30, p = 0.026), initial tumor diameter greater than 25 mm (HR 2.23, 95% CI 1.44–3.38, p = 0.0004), and the absence of calcification (HR 4.57, 95% CI 2.69–8.20, p < 0.0001) were factors associated with a short time to progression. Volumetric growth was seen in 74.0% of the cases. Factors associated with a higher annual growth rate were male sex (p = 0.0002), initial tumor diameter greater than 25 mm (p < 0.0001), MR imaging T2 signal hyperintensity (p = 0.0001), presence of symptoms (p = 0.037), and edema (p < 0.0001). Conclusions Although the authors could obtain variable results depending on the measurement method, the data demonstrate patients younger than 60 years of age and those with meningiomas characterized by hyperintensity on T2-weighted MR imaging, no calcification, diameter greater than 25 mm, and edema need to be observed more closely. Volumetry was more sensitive to detecting tumor growth than measuring the linear diameter.

Growth kinetics and outcomes of cT1b renal masses under active surveillance.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 440-440
Author(s):  
Reza Mehrazin ◽  
Marc C. Smaldone ◽  
Alexander Kutikov ◽  
Jeffrey J. Tomaszewski ◽  
Tianyu Li ◽  
...  
Keyword(s):  
Growth Rate ◽  
Tumor Growth ◽  
Metastatic Disease ◽  
Growth Kinetics ◽  
Tumor Size ◽  
Renal Tumors ◽  
Tumor Growth Rate ◽  
Renal Masses ◽  
Delayed Intervention

440 Background: The natural history of untreated T1b renal masses is poorly understood. We assessed the growth kinetics and outcomes of ≥cT1b cortical renal tumors which continue to remain on radiographic AS compared to those who underwent definitive surgery after a period of AS. Methods: Prospectively maintained, renal tumor database was reviewed to identify enhancing solid and cystic masses managed expectantly from 2000-2012. cT1a masses, transitional cell carcinoma or those suspected for metastatic disease were excluded from analysis. Localized tumors > 4.0 cm (≥T1b) that were radiographically followed for > 6 months were included for analysis. Clinical and pathological records were reviewed to determine tumor growth rate and clinical outcomes in those remained on AS or those who underwent delayed intervention. Mean for tumor size on presentation, annual linear tumor growth rate (LGR), Charlson comorbidity index (CCI), and follow-up (FU) were calculated. Chi−square test & Logistic regression were used for uni- and multi-variable analyses. Results: Of 457 pts managed with AS, 67 cT1b tumors (in 63 patients) were identified. 43 pts (67%) were managed solely with AS, while 21 pts (33%) progressed to intervention. The median age at presentation pts managed with AS and intervention was 77 and 60 yrs respectively (p=0.0002), while no difference was observed in median CCI (3 vs. 2, p=0.6). No difference was observed in tumor size at presentation between pts managed with AS and those undergoing delayed intervention (5.9 vs. 5.4 cm, p=0.8). In contrast, the mean LGR significantly differed between pts managed expectantly and pts progressed to intervention (0.37 vs. 0.73 cm/yr; p=0.02). On MVA, age (OR=0.9,CI:0.8−0.98) and LGR (OR=11,CI:1.8−60) were significant predictors of surgical intervention. With a mean FU period of 38.9 ± 24.0 months (6−105), 9 pts died (14%) from other cause and no pt progressed to metastatic disease. Conclusions: Localized cT1b≥ renal masses show comparable growth rates to small tumors managed expectantly with low rates of progression to metastatic disease with short term follow up. An initial period of AS to determine tumor growth kinetics is a reasonable option in select pts with significant competing risks and limited life expectancy.

Conservative Treatment of Patients with Acoustic Tumors

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 646-651 ◽  
Author(s):  
Joshua B. Bederson ◽  
Klaus von Ammon ◽  
Werner W. Wichmann ◽  
Gazi M. Yasargil
Keyword(s):  
Growth Rate ◽  
Conservative Treatment ◽  
Tumor Growth ◽  
Tumor Size ◽  
Tumor Growth Rate ◽  
Computed Tomographic ◽  
High Incidence ◽  
The Mean ◽  
Slow Growing

Abstract Seventy of 178 patients with acoustic tumors initially were treated conservatively and have been followed up for an average of 26 ± 2 months. The tumor size was determined by the mean maximum anteroposterior and mediolateral diameters, using computed tomographic or magnetic resonance imaging scans obtained sequentially throughout the follow-up period. The average tumor growth was 1.6 ± 0.4 mm the 1st year, and 1.9 ± 1.0 mm the 2nd year (range, -2 to 17 mm/y): 4 tumors showed apparent regression, 28 (40%) had no detectable growth, and 37 (53%) exhibited growth (average, 3.8 ± 1.2 mm/y). Within individual patients, the tumor growth rate determined during the 1st year of follow-up was predictive of tumor growth rate during the following year. Rapid tumor growth or clinical deterioration in 9 of the 70 patients (13%) who initially were treated conservatively necessitated subsequent surgery an average of 14 ± 5 months after the patient was initially seen. This group had a larger initial tumor size (27.0 ± 3.4 mm vs. 21.3 ± 0.9 mm, P&lt;0.05), and a faster 1-year growth rate (7.9 ± 2.3 mm/y vs. 1.3 ± 0.3 mm/y, P&lt;0.05) than the 61 patients who did not require surgery. Two patients, however, experienced neurological deterioration that required surgery, even though there was no tumor growth. The high incidence of acoustic tumors with no detectable growth or apparent spontaneous regression must be taken into account when evaluating the indications for surgery and the efficacy of radiotherapy. Beacuse surgery carries some risk and acoustic tumors are generally slow growing, a trial of conservative treatment is possible in selected patients, provided serial radiological studies are obtained. Knowledge of the tumor growth rate established by these studies may be helpful in the treatment of individual patients.

Natural History of Microprolactinomas: Six-Year Follow-up

Neurosurgery ◽  
1983 ◽  
Vol 12 (2) ◽  
pp. 180-183 ◽  
Author(s):  
Martin H. Weiss ◽  
James Teal ◽  
Peggy Gott ◽  
Robert Wycoff ◽  
Richard Yadley ◽  
...  
Keyword(s):  
Natural History ◽  
Tumor Growth ◽  
Surgical Intervention ◽  
Short Term ◽  
Significant Growth ◽  
The Face ◽  
History Of ◽  
Early Surgical Intervention

Abstract A 6-year follow-up of patients harboring microprolactinomas suggests that few patients (3 of 27) demonstrate significant growth of their tumor during this time. The major hazard for such patients who are not treated seems to be their risk for the development of premature osteoporosis in the face of sustained hyperprolactinemia. The risks of this complication may exceed the risks of early surgical intervention in selected patients. This short term risk of tumor growth (about 10%) must be weighed in the decision about therapeutic endeavors.

scholarly journals Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

2019 ◽  
Vol 110 (7-8) ◽  
pp. 595-603 ◽  
Author(s):  
Alberto Stefano Tresoldi ◽  
Giulia Carosi ◽  
Nazarena Betella ◽  
Giulia Del Sindaco ◽  
Rita Indirli ◽  
...  
Keyword(s):  
Natural History ◽  
Tumor Size ◽  
Older Patients ◽  
Small Scale ◽  
Inclusion Criteria ◽  
Growth Trend ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
History Of

Introduction: Available data on pituitary incidentalomas mostly derive from small-scale studies, with heterogeneous inclusion criteria and limited follow-up. No paper has focused specifically on clinically nonfunctioning pituitary in­cidentalomas (CNFPIs). Objective: To describe the charac­teristics and the natural history of patients diagnosed with CNFPIs. Methods: Retrospective multicenter cohort study evaluating hormonal, imaging, and visual field characteristics at diagnosis and during follow-up of CNFPIs investigated in 2 Pituitary Centers. Results: Three hundred and seventy-one patients were included (50.9% microadenomas, 35.6% males). Men were older and more likely to have a macroadenoma (p < 0.01). Totally, 23.7% of patients presented secondary hormonal deficits (SHDs), related to tumor size (higher in macroadenomas; p < 0.001) and age (higher in older patients; p < 0.001). Hypogonadism was the most frequent SHD (15.6%). Two hundred and ninety-six patients had follow-up data, 29.1% required surgery after first evaluation, and 97 had at least 3 years of follow-up. In total, 15.3% adenomas grew (more macroadenomas), but only in microadenomas patients with longer follow-up showed a higher growth trend. Totally, 5.2% of patients developed new SHDs (micro- vs. macroadenomas p = 1.000), and in 60% of them this was not associated with an increase in tumor size. Thirteen additional patients required surgery during follow-up (1 microadenoma at diagnosis). Conclusions: Macroadenomas and age are risk factors for SHD in CNFPIs, which occur at diagnosis in a quarter of patients. During follow-up, macroadenomas tend to grow more often, but microadenomas display higher growth trend as follow-up increases. Deterioration of pituitary function is not always related to adenoma growth.

The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients

1995 ◽  
Vol 83 (2) ◽  
pp. 222-224 ◽  
Author(s):  
William C. Olivero ◽  
J. Richard Lister ◽  
Patrick W. Elwood
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Size ◽  
Imaging Techniques ◽  
Maximum Diameter ◽  
Content Type ◽  
Clinical Records ◽  
Fine Print ◽  
Rule Out

✓ Little is known about the natural history and growth rate of asymptomatic meningiomas. To better delineate this problem, the authors reviewed the clinical records and imaging studies of the last 60 patients diagnosed with asymptomatic meningiomas at their institution. There were 45 women and 15 men, whose ages ranged from 38 to 84 years, with a mean age of 66 years. The most common tumor location was convexity (25 patients), but virtually all locations were represented. Three patients were lost to follow up. The average clinical follow-up review of the remaining 57 patients was 32 months (range 6 months to 15 years). None of the patients became symptomatic from an enlarging tumor during their follow-up period. Typically, once a meningioma was diagnosed, follow-up scans were obtained at 3 months, 9 months, and then yearly or every other year thereafter. Forty-five patients underwent follow-up scans, with comparison of tumor size to that found on the initial scan, over a period ranging from 3 months to 15 years. Thirty-five patients have shown no growth in their tumor size, with an average imaging follow up of 29 months (range 3–72 months). Ten patients have shown tumor growth calculated as an increase in the maximum diameter of the tumor. This growth ranged from 0.2 cm over 180 months to 1 cm over 12 months, with an average of 0.24 cm per year. Average imaging follow up for these patients was 47 months (range 6 months to 15 years). The authors conclude that patients with asymptomatic meningiomas need close clinical and radiological follow up to rule out other disease processes and to rule out rapidly enlarging tumors. Although the average follow-up time was short, the vast majority of these tumors appeared to show minimal or no growth over periods of time measured in years. With modern noninvasive imaging techniques, these tumors can be safely observed until they enlarge significantly or become symptomatic.

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