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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 3
| Issue : 4 | Page : 888 |
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Authors' reply to Vaish
Akheel Mohammad1, Ashmi Wadhwania2
1 Consultant Head & Neck Oncosurgeon/ Reconstruction Surgeon, Indore, M.P, India
2 Consultant Oral and Facio-Maxillary Surgeon, Indore, M.P, India
| Date of Submission | 23-Oct-2020 |
| Date of Decision | 04-Dec-2020 |
| Date of Acceptance | 04-Dec-2020 |
| Date of Web Publication | 25-Dec-2020 |
Correspondence Address:
Akheel Mohammad
Consultant Head & Neck Oncosurgeon/ Reconstruction Surgeon, Indore, M.P
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/CRST.CRST_337_20
How to cite this article:
Mohammad A, Wadhwania A. Authors' reply to Vaish. Cancer Res Stat Treat 2020;3:888 |
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 | |  |
| 1. | Vaish R. Schwannoma of the head and neck: Is it always about surgery? Cancer Res Stat Treat 2020;3:886-7.  [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. [Full text] |
| 3. | Shah JP, Patel SG, Singh B. Jatin Shah's Head and Neck Surgery and Oncology E-Book.6 th edition, USA.: Elsevier Health Sciences; 2012. |
| 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. |
| 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. |
| 6. | Mandl ES, Meijer OW, Slotman BJ, Vandertop WP, Peerdeman SM. Stereotactic radiation therapy for large vestibular schwannomas. Radiother Oncol 2010;95:94-8. |
| 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. |
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