Évolution des schwannomes vestibulaires et qualité de vie en fonction de la prise en charge des patients

Abstract : Vestibular schwannoma (VS) is a benign and slow growing tumour with a controversial therapeutic strategy. The aim of this study was to compare the quality of life (QoL) according to the 3 therapeutic modalities of small to medium-sized VS, observation, radiotherapy, and microsurgery, and to analyze the natural history of tumour growth and hearing level following the diagnosis of VS. Our retrospective monocentric study included 239 patients with sporadic unilateral small- to medium-sized VS. Patient and tumour characteristics were collected, as well as therapeutic modalities. QoL was measured by French versions of Short Form-36 Health Survey (SF-36) and Penn Acoustic Neuroma Quality of Life (PANQOL) scales. Over 6 months, QoL scales of 138 patients were analysed. A better QoL was found for observation compared to microsurgery using PANQOL, Hearing, Facial, Balance and Energy sub-domains. For patient under 65 years old, a difference was found between microsurgery and observation for Hearing and Balance subdomains only, whereas older patients had a worth QoL after microsurgery using PANQOL score and all PANQOL sub-domains except Anxiety and General health. Natural history of VS found 54% of stable tumour on MRI and 68% of hearing preservation after 5 years of follow-up. Wait and scan strategy appeared to be an excellent initial therapeutic strategy for small to medium-sized VS with better QoL, high rate of hearing preservation and low probability of growth. Patients over 65 years old appeared to recover more hardly after surgery than younger patient. A prospective study comparing PANQOL score before and after active treatment might help for the therapeutic decision.
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Submitted on : Wednesday, February 20, 2019 - 2:54:14 PM
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Sami Wajsbrot. Évolution des schwannomes vestibulaires et qualité de vie en fonction de la prise en charge des patients. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02042620⟩



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