Size Threshold Surveillance: A Revised Approach to Wait-and-Scan Management in Sporadic Vestibular Schwannoma

PROGRAM DESCRIPTION: Population-based data indicate that observation with serial imaging represents the most common initial approach to newly diagnosed sporadic vestibular schwannoma globally. Inextricably linked to this trend in management is the reality that the average patient with sporadic vestibular schwannoma is now diagnosed at a smaller tumor size, at an older age, with less severe symptoms, or occasionally incidentally. In the existing paradigm, most tumors are either treated upfront or after demonstrating initial growth with either microsurgery or radiosurgery.

Emerging natural history data from large, international cohorts provide evidence to support a shift in the current wait-and-scan management paradigm, particularly for the majority of newly diagnosed patients who have small- to medium-sized tumors. Specifically, a revised approach that allows for some degree of tumor growth during observation up until a size threshold range is supported. Beyond this size threshold range, further tumor growth places the patient at accelerated rates of poorer post-treatment outcomes. This revised approach allows greater flexibility for providers offering observation management. Particularly in light of quality-of-life and cost-effectiveness data – as well as a potential for ongoing overtreatment of vestibular schwannoma suggested by population-based data – a shift in the conceptualization of wait-and-scan management for sporadic vestibular schwannoma is needed.

The current panel presentation will cover updates in the understanding of the natural history of sporadic vestibular schwannoma published over the last 5 years. In combination with epidemiological evidence surrounding treatment trends, quality of life data, and cost-effectiveness research, these insights into the natural history of sporadic vestibular schwannoma will then be used to reframe wait-and-scan management for the average, newly diagnosed patient who harbors a small- to medium-sized sporadic vestibular schwannoma.