From the Guidelines
The treatment of schwannoma should be individualized based on clinical presentation, tumor size, and expertise of the treating center, with options including observation, surgical resection, fractionated radiotherapy, and radiosurgery, as recommended by the European Association of Neuro-Oncology 1. When managing schwannoma, it is essential to consider the patient's overall health and the potential impact of treatment on their quality of life.
- Key factors in determining the best course of treatment include:
- Tumor size and location
- Presence of symptoms, such as pain, numbness, or hearing loss
- Patient's overall health and medical history
- Expertise of the treating center According to the European Association of Neuro-Oncology guideline on the diagnosis and treatment of vestibular schwannoma 1, the choice of treatment depends on these factors, with observation being a viable option for small, asymptomatic tumors, and surgical decompression being mandatory for large tumors, potentially followed by fractionated radiotherapy or radiosurgery.
- Treatment options for schwannoma include:
- Observation for small, asymptomatic tumors
- Surgical resection for larger or symptomatic tumors
- Fractionated radiotherapy as an alternative to surgery
- Radiosurgery for patients who cannot undergo surgery It is crucial to note that, except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy in the treatment of schwannoma, as stated in the guideline 1.
- The prognosis for patients with schwannoma is generally excellent, with complete surgical removal usually being curative, although there is a small risk of recurrence, highlighting the importance of careful treatment planning and follow-up.
From the Research
Definition and Treatment of Schwannoma
- Schwannoma is a benign peripheral nerve sheath tumor composed of Schwann cells, caused by genetic mutation or deletion 2.
- The primary treatment options for schwannoma are surgery and radiotherapy, particularly stereotactic radiosurgery (SRS) 3.
Types of Schwannoma and Treatment Approaches
- Vestibular schwannomas (VS) are the most common benign intracranial nerve sheath tumors, and SRS is the dominant treatment for small- and medium-sized VS and selected larger tumors 3.
- For asymptomatic cases of seminal vesical schwannoma, a conservative strategy might be an effective treatment option, with periodic computed tomography or magnetic resonance imaging scans to estimate the alteration of the lesion 2.
- Patient choice in treatment of vestibular schwannoma includes watchful waiting, stereotactic radiosurgery, and surgical removal, with factors such as age, tumor size, and clinical presentation influencing the decision 4.
Radiation Therapy for Vestibular Schwannoma
- Fractionated radiation therapy is a management paradigm for patients with vestibular schwannomas, aiming to achieve excellent local tumor control and optimize functional outcomes with minimal treatment-related morbidity 5.
- Radiation therapy and radiosurgery for vestibular schwannomas have specific indications, techniques, and results, with SRS and stereotactic radiotherapy (SRT) being used for small and large tumors, cystic tumors, and NF2-associated VS 6.