Acoustic neuroma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohsen Basiri M.D.

Overview

The mainstay of therapy for acoustic neuroma is surgery and radiation therapy. Since acoustic neuroma tends to be slow-growing and is a benign tumor, careful observation with follow-up MRI scans every 6 to 12 months may be appropriate for elderly patients, patients with small tumors, patients with significant medical conditions, and patients who refuse treatment.

Medical Therapy

The mainstay of therapy for acoustic neuroma is surgery and radiation therapy. Since acoustic neuroma tends to be slow-growing and is a benign tumor, careful observation with follow-up MRI scans every 6 to 12 months may be appropriate among the following groups of patients:[1][2]

Observation

The strategies for patient observation include:

Radiation Therapy

Radiation therapy approaches that have been used in patients with acoustic neuroma include:

Stereotactic Radiosurgery

Stereotactic radiosurgery (SRS), is a treatment option for patients with tumors smaller than 3 cm or for enlarging tumors in patients with significant medical conditions and are not candidates for surgery. It delivers multiple precisely-targeted radiation convergent beams to minimize injury to adjacent structures. This can be accomplished with either the gamma knife or a linear accelerator.[4][5]

Stereotactic radiotherapy

  • Stereotactic radiotherapy (SRT) and fractionated stereotactic radiotherapy deliver smaller doses of radiation over a period of time, requiring the patient to return to the treatment location on a daily basis, from 3 to 30 times, generally over several weeks.
  • Each visit lasts a few minutes and most patients are free to go about their daily business before and after each treatment session.
  • Early data indicates that SRT may result in better hearing preservation when compared to single-session SRS.[6]

Proton beam therapy

References

  1. Wissame El Bakkouri, Romain E. Kania, Jean-Pierre Guichard, Guillaume Lot, Philippe Herman & Patrice Tran Ba Huy (2009). "Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment". Journal of neurosurgery. 110 (4): 662–669. doi:10.3171/2007.5.16836. PMID 19099381. Unknown parameter |month= ignored (help)
  2. Eric E. Smouha, Michael Yoo, Kristi Mohr & Raphael P. Davis (2005). "Conservative management of acoustic neuroma: a meta-analysis and proposed treatment algorithm". The Laryngoscope. 115 (3): 450–454. doi:10.1097/01.mlg.0000175681.52517.cf. PMID 15744156. Unknown parameter |month= ignored (help)
  3. Wissame el Bakkouri, M.D., romain e. kania, M.D., Ph.D., Jean-Pierre Guichard, M.D., Guillaume lot, M.D., Philippe herman, M.D., Ph.D., and Patrice tran Ba huy, M.D. (2007). "Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment". J Neurosurg. 11: 662.
  4. Marianna Karpinos, Bin S. Teh, Otto Zeck, L. Steven Carpenter, Chris Phan, Wei-Yuan Mai, Hsin H. Lu, J. Kam Chiu, E. Brian Butler, William B. Gormley & Shiao Y. Woo (2002). "Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery". International journal of radiation oncology, biology, physics. 54 (5): 1410–1421. PMID 12459364. Unknown parameter |month= ignored (help)
  5. Joseph C. T. Chen & Michael R. Girvigian (2005). "Stereotactic radiosurgery: instrumentation and theoretical aspects-part 1". The Permanente journal. 9 (4): 23–26. PMID 22811641. Unknown parameter |month= ignored (help)
  6. Marianna Karpinos, Bin S. Teh, Otto Zeck, L. Steven Carpenter, Chris Phan, Wei-Yuan Mai, Hsin H. Lu, J. Kam Chiu, E. Brian Butler, William B. Gormley & Shiao Y. Woo (2002). "Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery". International journal of radiation oncology, biology, physics. 54 (5): 1410–1421. PMID 12459364. Unknown parameter |month= ignored (help)
  7. W. P. Levin, H. Kooy, J. S. Loeffler & T. F. DeLaney (2005). "Proton beam therapy". British journal of cancer. 93 (8): 849–854. doi:10.1038/sj.bjc.6602754. PMID 16189526. Unknown parameter |month= ignored (help)
  8. David A. Bush, Calvin J. McAllister, Lilia N. Loredo, Walter D. Johnson, James M. Slater & Jerry D. Slater (2002). "Fractionated proton beam radiotherapy for acoustic neuroma". Neurosurgery. 50 (2): 270–273. PMID 11844261. Unknown parameter |month= ignored (help)

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