Naše zkušenosti s „Wait and Scan“ protokolem v léčbě vestibulárního schwannomu.

Study objectives: Most vestibular schwannomas (VS) grow very slowly, only some of them grow rapidly. Observation is a strategy with selected patients. The aim is to evaluate strategy Wait and Scan. Patients and Methods: In the period 1999-2016, 86 patients with VS were diagnosed. There were 24 patients (28%) were treated surgically, 33 patients (38%) were treated with Leksell Gamma Knife. 29 patients (34%) were indicated for „Wait and Scan" Protocol. Of these 29 patients, 18 patients were monitored for a long time (follow-up period average of 6 years). Reasons for observations included tumour volume, stage I (61%), advanced age (17%), patient preference (17%), poor health condition (5%). Data on one-year monitored VS were evaluated retrospectively. Results: Observations period 2 – 17 years, 6 years in average. 11 patients (61%) were successfully observed without the need for conversion to active treatment, 7 patients (39%) ultimately required active treatment within a mean interval of 3.5 years since diagnosis. 9 tumours (50%) did not grow and 9 tumours (50%) increased their volumes during the observations (2 patients still observed - because of high age and the patient's wishes). The average year-on-year rate of tumor growth during the annual follow-up was significantly higher statistically (p=0.01 and 0.05) in the group requiring conversion to an active approach rather than in the group of observed patients. Significant tumour growth was observed up to 5 years after diagnosis, a later VS growth has not been reported. Conclusion: Observations of VS is a rational strategy for carefully selected patients. The growth rate of the tumour during the annual follow-up was a strong predictor of the potential need for a proactive approach to treatment. Attention should be paidto the identification of fast-growing and progressive VS, as these must be identified in time and possibly indicated them for active treatment. [ABSTRACT FROM AUTHOR]