From the Guidelines
Treatment for schwannoma should be individualized based on the tumor's size, location, and symptoms, with options including observation, surgical resection, fractionated radiotherapy, and radiosurgery, as recommended by the most recent guidelines 1.
Treatment Options
The choice of treatment depends on various factors, including clinical presentation, tumor size, and expertise of the treating center.
- Observation with regular MRI monitoring is suitable for small, asymptomatic schwannomas, as these benign tumors often grow slowly or may not grow at all.
- Surgical resection is the primary treatment for symptomatic schwannomas, with the goal of complete tumor removal while preserving nerve function.
- Stereotactic radiosurgery (SRS) is an alternative for patients who are poor surgical candidates or have tumors in difficult locations, delivering precise radiation to control tumor growth while minimizing damage to surrounding tissues.
Recent Guidelines
According to the International Stereotactic Radiosurgery Society (ISRS) practice guidelines 1, SRS is associated with reduced treatment-related adverse effects compared to microsurgical resection and similar hearing preservation compared to conservative surveillance.
Considerations
Treatment decisions should prioritize preserving neurological function while controlling the tumor, taking into account the patient's age, overall health, tumor characteristics, and symptoms 1.
- For vestibular schwannomas, hearing preservation strategies may include hearing aids or cochlear implants.
- Pain management with medications like gabapentin or pregabalin may be needed for symptomatic relief.
From the Research
Treatment Options for Schwannoma
The treatment options for a patient diagnosed with a schwannoma include:
- Surgery: often considered for larger tumors or those causing significant symptoms 2, 3
- Radiotherapy: particularly stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) 2, 4, 5, 3
- Conservative management: also known as "wait and scan," which involves regular MRI scanning to monitor tumor progression 4
Stereotactic Radiosurgery (SRS)
SRS is a dominant treatment for small- and medium-sized vestibular schwannomas due to its excellent local control rates and favorable safety profile compared to surgery 2. However, careful treatment planning is essential, taking into account patient preferences, tumor location and size, symptoms, and anticipated treatment-related toxicity.
Fractionated Stereotactic Radiotherapy (FSRT)
FSRT can be used for larger inoperable lesions, and several literature data support its use in these cases 3. However, there are limited data demonstrating safety and efficacy of fractionated SRT for the treatment of larger tumors 6.
Conservative Management
Conservative management causes significantly less complications and offers a higher quality of life compared with active treatments 4. Regular MRI scanning is necessary to monitor tumor progression, and significant growth is defined as an increase of at least 3 mm in the largest extrameatal diameter in any plane between the first and last available scans 4.
Tumor Growth Control and Complications
Tumor growth control was established in 97.5% of cases treated with SRS using CyberKnife system, and stabilization of auditory function was achieved in 77.5% of series 5. Facial nerve palsy after stereotactic radiation treatment was observed in 2 cases (3%), and incidence of trigeminal nerve dysfunction was significantly higher: sensation disturbances occurred in 6 (10%) patients 5.