Vestibular Schwannomas: implementation of PANQOL and Mayo VSQOL Index scales in Ukraine and justification of treatment strategy with preservation of quality of life (problem analysis, own experience, discussion points)

Abstract

Objective: To evaluate the treatment outcomes of sporadic vestibular schwannomas (VS) to substantiate the choice of optimal treatment strategy considering quality of life indicators using the Penn Acoustic Neuroma Quality of Life Scale (PANQOL) and the Mayo Clinic Vestibular Schwannoma Quality of Life Index (Mayo VSQOL Index) scales in Ukraine. Materials and Methods: 1100 patients with VS were treated at the Subtentorial Neurooncology Department from 2001 to October 2023 and 373 were primarily considered for dynamic observation (“wait-and-scan”) at the Department of Ear Microsurgery and Otoneurosurgery of the Kolomiichenko Otolaryngology Institute. Data on 359 patients (some of whom underwent surgery in the mentioned departments) who received radiotherapy (RT) from 2010 to 2023 in the Radioneurosurgery Department are also provided. The PANQOL and Mayo VSQOL Index scales were implemented to assess the quality of life of patients with VS. Scientific publications from the PubMed database related to the study of the quality of life in patients with VS were analyzed. Results: The analysis was based on patient data from the database for the period 2017 - October 2023, 391 patients with VS were treated, including 359 who underwent surgical treatment (schwannomas resection), 4 – tarsorrhaphy after VS resection, and 28 who received combined treatment (surgery + radiotherapy). A separate group consisted of 359 patients who underwent radiotherapy (RT). Of 177 patients who underwent radiosurgical treatment, 65 (36.7%) had Stage III VS according to the classification of W.T. Koos, and 112 (63.3%) had stage IV VS. Primarily diagnosed tumors were treated in 110 (62.1%) and 67(37.9%) patients with residual postoperative. Follow-up data were obtained for 159 patients. At the Kolomiichenko Otolaryngology Institute, 373 patients were under observation with the primary "wait-and-scan" strategy, of whom 110 (29.5%) had their VS removed due to symptom progression or progressive course, and 24 (6.4%) underwent RT. Of the 27 patients in the Subtentorial Neurooncology Department study group, 7 (25.9%) underwent surgery, and 5 (18.5%) underwent RT. Conclusions: Global practice in assisting patients with VS indicates a shift towards dynamic follow-up and an increase in the frequency of using radiation treatment methods. Over the past years, strategy have been proposed that do not recommend the "wait-and-scan" mode due to the risk of life-threatening complications associated with tumor growth. However, there is very little data on long-term outcomes (more than 5 years) and quality of life. VS primarily detected by magnetic resonance imaging in Ukraine significantly larger (Koos III-IV) than those reported in the literature. The implementation of specialized scales for assessing the quality of life of VS patients in Ukraine will help improve outcomes by applying personalized criteria for treatment routes, increasing the level of awareness and responsibility of both patients and doctors.