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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 888

Authors' reply to Vaish


1 Consultant Head & Neck Oncosurgeon/ Reconstruction Surgeon, Indore, M.P, India
2 Consultant Oral and Facio-Maxillary Surgeon, Indore, M.P, India

Date of Submission23-Oct-2020
Date of Decision04-Dec-2020
Date of Acceptance04-Dec-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Akheel Mohammad
Consultant Head & Neck Oncosurgeon/ Reconstruction Surgeon, Indore, M.P
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_337_20

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How to cite this article:
Mohammad A, Wadhwania A. Authors' reply to Vaish. Cancer Res Stat Treat 2020;3:888

How to cite this URL:
Mohammad A, Wadhwania A. Authors' reply to Vaish. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 25];3:888. Available from: https://www.crstonline.com/text.asp?2020/3/4/888/305002



We concur with Dr. Vaish that surgery is not always the primary modality of treatment for schwannomas of the head-and-neck.[1] In our review article,[2] we have focused on all the modalities for the management of schwannomas; however, in this letter, we will focus on radiotherapy which is administered to some patients considering the age of the patient and the number of cranial nerves involved. Intraoperative nerve monitoring is certainly very helpful for preventing inadvertent nerve injuries but is not always available in all the setups. When deciding the treatment modality, the most important aspect to consider is the age of the patient. If the patient is young and the clinical and radiological examinations reveal a schwannoma with single cranial nerve involvement, surgery remains the primary treatment modality. If multiple cranial nerves are involved, the mass should be observed till it starts growing. If it grows in size, radiation or surgery can be considered. In older or compromised patients, observation is the primary modality for disease management, and radiation can be considered if it shows signs of growth. These recommendations are in accordance with the age-related algorithm.[3]

Radiotherapy is effective in arresting the growth of schwannoma and its stabilization, but not in its eradication. Radiotherapy includes conventional fractionated external beam radiotherapy, stereotactic radiosurgery, and gamma knife radiosurgery, and has shown good results.[4],[5],[6] Recently, intensity-modulated radiation therapy at a dose of 45 to 54 Gy has been used. Transient cranial nerve palsies have been reported. When selecting patients for radiotherapy, radiation-induced secondary malignancies must be considered.[7] In such patients, a metaiodobenzylguanidine scan is performed. If the tumor tests positive on this scan, somatostatin analog inhibitors should be used which cause the tumor to shrink by 15%.[1] Hence, radiation is reserved only for older or compromised patients with multi-nerve involvement as they are not fit for surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vaish R. Schwannoma of the head and neck: Is it always about surgery? Cancer Res Stat Treat 2020;3:886-7.   Back to cited text no. 1
  [Full text]  
2.
Mohammad A, Iqbal MA, Wadhwania A. Schwannomas of the head and neck region: A report of two cases with a narrative review of the literature. Cancer Res Stat Treat 2020;3:517-25.  Back to cited text no. 2
  [Full text]  
3.
Shah JP, Patel SG, Singh B. Jatin Shah's Head and Neck Surgery and Oncology E-Book.6th edition, USA.: Elsevier Health Sciences; 2012.  Back to cited text no. 3
    
4.
Spiegelmann R, Lidar Z, Gofman J, Alezra D, Hadani M, Pfeffer R. Linear accelerator radiosurgery for vestibular schwannoma. J Neurosurg 2001;94:7-13.  Back to cited text no. 4
    
5.
Hirato M, Inoue H, Zama A, Ohye C, Shibazaki T, Andou Y. Gamma knife radiosurgery for acoustic schwannoma: Effects of low radiation dose and functional prognosis. Stereotact Funct Neurosurg 1996;66 Suppl 1:134-41.  Back to cited text no. 5
    
6.
Mandl ES, Meijer OW, Slotman BJ, Vandertop WP, Peerdeman SM. Stereotactic radiation therapy for large vestibular schwannomas. Radiother Oncol 2010;95:94-8.  Back to cited text no. 6
    
7.
Sordillo PP, Helson L, Hajdu SI, Magill GB, Kosloff C, Golbey RB, et al. Malignant schwannoma – Clinical characteristics, survival, and response to therapy. Cancer 1981;47:2503-9.  Back to cited text no. 7
    




 

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