Pretreatment Growth Rate Predicts Radiation Response in Vestibular Schwannomas
| Autor: | Jay S. Loeffler, Michael J. McKenna, Mykol Larvie, Helen A. Shih, Nina N. Niu, Hugh D. Curtin, Andrzej Niemierko |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Neurofibromatosis 2 Cancer Research Medical surveillance medicine.medical_treatment Growth Stereotactic radiation therapy Radiosurgery Proton Therapy medicine Tumor Expansion Humans Radiology Nuclear Medicine and imaging Growth rate Neurofibromatosis type 2 Adverse effect Aged Retrospective Studies Aged 80 and over Photons Radiation medicine.diagnostic_test business.industry Radiotherapy Dosage Magnetic resonance imaging Neuroma Acoustic Middle Aged Prognosis medicine.disease Magnetic Resonance Imaging Tumor Burden Radiation therapy Oncology Disease Progression Linear Models Female Nuclear medicine business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 89:113-119 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2014.01.038 |
| Popis: | Purpose Vestibular schwannomas (VS) are often followed without initial therapeutic intervention because many tumors do not grow and radiation therapy is associated with potential adverse effects. In an effort to determine whether maximizing initial surveillance predicts for later treatment response, the predictive value of preirradiation growth rate of VS on response to radiation therapy was assessed. Methods and Materials Sixty-four patients with 65 VS were treated with single-fraction stereotactic radiation surgery or fractionated stereotactic radiation therapy. Pre- and postirradiation linear expansion rates were estimated using volumetric measurements on sequential magnetic resonance images (MRIs). In addition, postirradiation tumor volume change was classified as demonstrating shrinkage (ratio of volume on last follow-up MRI to MRI immediately preceding irradiation 120%). The median pre- and postirradiation follow-up was 20.0 and 27.5 months, respectively. Seven tumors from neurofibromatosis type 2 (NF2) patients were excluded from statistical analyses. Results In the 58 non-NF2 patients, there was a trend of correlation between pre- and postirradiation volume change rates (slope on linear regression, 0.29; P =.06). Tumors demonstrating postirradiation expansion had a median preirradiation growth rate of 89%/year, and those without postirradiation expansion had a median preirradiation growth rate of 41%/year ( P =.02). As the preirradiation growth rate increased, the probability of postirradiation expansion also increased. Overall, 24.1% of tumors were stable, 53.4% experienced shrinkage, and 22.5% experienced expansion. Predictors of no postirradiation tumor expansion included no prior surgery ( P =.01) and slower tumor growth rate ( P =.02). The control of tumors in NF2 patients was only 43%. Conclusions Radiation therapy is an effective treatment for VS, but tumors that grow quickly preirradiation may be more likely to increase in size. Clinicians should take into account tumor growth rate when counseling patients about treatment options. |
| Databáze: | OpenAIRE |
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