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 benign tumor, careful observation with follow-up MRI scans every 6 to 12 months may be appropriate for elderly patients or patients with small tumors, or among 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 benign tumor, careful observation with follow-up MRI scans every 6 to 12 months may be appropriate among following groups of patients:[1][2]

  • Patients with a tumor in their only hearing or better hearing ear
  • When the tumor is of a size that hearing preservation with treatment would be unlikely
  • Elderly patients
  • Small tumors in older individuals that do not grow
  • Patients with small tumors with good hearing
  • Patients with medical conditions that increase the risk of surgery
  • Patients who refuse treatment
  • Patients with a tumor on the side of an only hearing ear or only seeing eye

Observation

The strategies for patient observation include:

  • Assessment of facial nerve function, hearing, tinnitus and ataxia.
  • An MRI is performed every 6 months or yearly depending on the rate of tumor growth.
  • The average growth rate of tumor is 1.15 to 2.4 mm per year. If the tumor grows or causes serious symptoms, treatment is suggested. If the scans show the tumor is growing or If the tumor causes progressive symptoms or other difficulties, considering surgical intervention is mandatory. [3]

Radiation Therapy

Another treatment option for an acoustic neuroma is radiation. 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 centimeter 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), fractionated stereotactic radiotherapy, delivers 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

  • The use of proton beam therapy permits the delivery of high doses of radiotherapy to the target volume while limiting the dose received by surrounding tissues. It provides maximum local tumor control with minimum cranial nerve injuries.[7]
  • In comparison with conventional radiation therapy that electromagnetic waves in X-rays pass through target and adjacent tissues, in proton therapy, energy is carried by protons beams and the majority of the energy being deposited within the target.It provides excellent local control of acoustic neuromas with acceptable preservation of hearing and facial and trigeminal nerve function.[8]

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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