Volumetric growth rates of untreated vestibular schwannomas

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OBJECTIVE

There remains a large discrepancy among surgeons in expectations of vestibular schwannoma (VS) growth. The anticipated growth rate of a VS and its potential clinical impact are important factors when deciding whether to observe the lesion over time or to intervene. Previous studies of VS natural growth remain limited, mostly confined to linear measurements, often without high-resolution, thin-sequence imaging. The present study comprehensively assessed natural tumor growth rates using volumetric measurements.

METHODS

Between 2012 and 2018, 212 treatment-naïve patients diagnosed with a unilateral VS were evaluated. A total of 699 MR images were assessed, with a range of 2–11 MR images per patient. All MR images preceded any intervention, with patients subsequently being observed through completion of data analysis (36%) or treated with stereotactic radiosurgery (32%) or microsurgical resection (32%). To determine precise tumor volumes, the tumor area was outlined on every slice, and the products of the area and slice thickness were summed (99% of scans were ≤ 1-mm slice thickness). A multilevel model with random effects was used to assess the mean volume change over time. Each tumor was categorized as one of the following: growing (volume increase by more than 20% per year), fast growing (volume increase by more than 100% per year), stable (volume change between 20% decrease and 20% increase per year), and shrinking (volume decrease by more than 20% per year).

RESULTS

The mean VS volumetric growth rate was 33.5% per year (95% CI 26.9%–40.5%, p < 0.001). When assessing the frequencies of individual tumor annual growth rates, 66% demonstrated growth (30% fast growing), 33% were stable, and 1% exhibited shrinking over an average interval of 25 months. Larger tumors were associated with increased absolute growth, but there was no relationship between tumor size and proportional growth rate. There was also no relationship between patient age and tumor growth rate.

CONCLUSIONS

This study comprehensively assessed VS volumetric growth rates using high-resolution images and was conducted in a large and diverse patient sample. The majority of the tumors exhibited growth, with about one-third growing at a rate of 100% per year. These findings may contribute to a consensus understanding of tumor behavior and inform clinical decisions regarding whether to intervene or observe.

ABBREVIATIONS VS = vestibular schwannoma.

Article Information

Correspondence Douglas Kondziolka: NYU Langone Medical Center, New York, NY. douglas.kondziolka@nyumc.org.

INCLUDE WHEN CITING Published online August 2, 2019; DOI: 10.3171/2019.5.JNS1923.

Disclosures Dr. Kondziolka reports receiving non–study-related support for clinical or research efforts that he oversees from Brainlab.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Box plot demonstrating the distribution of tumor volumes based on the largest linear diameters in a single plane (grouped in 5-mm increments).

  • View in gallery

    Line graph demonstrating change in the natural log of volume per time. Each light gray line represents an individual patient, with each dot representing an MRI. The black line represents the regression line from the multilevel model, which takes into account all individuals. A slope of 0.289 (95% CI 0.238–0.340) results in a mean growth rate of 33.5% per year (95% CI 26.9%–40.5%, p < 0.001). ln = natural logarithmic function.

  • View in gallery

    Bar graph showing the frequencies of the VS growth categories. Each category corresponds to the following annual growth rates: shrinking (volume decrease by more than 20% per year), stable (volume change between 20% decrease and 20% increase per year), growing (volume increase by more than 20% per year), and fast growing (volume increase by more than 100% per year). Median and range of follow-up time in months reported.

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