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Shrivastava M, Emmanouil B, Mathew R, Halliday D, Parry A, Halliday J, Mackeith S. Stereotactic Radiosurgery and Radiotherapy for Vestibular Schwannoma in NF2-Related Schwannomatosis. Laryngoscope 2024; 134:2364-2371. [PMID: 37983868 DOI: 10.1002/lary.31180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To determine the long-term control rates and hearing outcomes for growing vestibular schwannoma in NF2-related schwannomatosis (NF2) treated with stereotactic radiosurgery (SRS) and fractionated radiotherapy (FRT). METHODS Retrospective review of all patients treated with SRS/FRT between 1986 and2021 from a tertiary NF2 unit. Overall tumor control was defined as: (1) growth control (growth failure was defined as growth in any dimension of 3 millimetres or more from baseline post-SRS/FRT), and (2) treatment control (no need for further intervention). Loss of serviceable hearing was defined as a drop in speech discrimination score below 50% after SRS/FRT. RESULTS There were 81 cases, with a mean duration of follow-up of 125 months. Overall control rate was 72% (58/81), with 80% (65/81) growth control and 74% (60/81) treatment control. There was a 5-year actuarial survival of 77% and 10-year survival of 71%. Forty-three percent (30/69) of cases did not have serviceable hearing at baseline. Of those remaining, 49% (19/39) preserved serviceable hearing during follow-up at a mean of 106 months. Actuarial survival for preservation of serviceable hearing at 5 and 10 years was 69% and 53%. There were poorer outcomes with increasing genetic severity, and with baseline tumor size >3 cm. No cases of SRS/FRT-related malignancy were identified at a mean follow-up of 10 years. CONCLUSION Stereotactic radiosurgery/fractionated radiotherapy are an effective option to treat growing vestibular schwannoma in patients with NF2 with the potential for hearing preservation in a proportion of patients. LEVEL OF EVIDENCE 4-Case Series Laryngoscope, 134:2364-2371, 2024.
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Affiliation(s)
- Manu Shrivastava
- Department of Ear, Nose and Throat Surgery, Oxford University Hospitals, Oxford, UK
| | - Beatrice Emmanouil
- NHS England, Wellington House, London, UK
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rajeev Mathew
- Department of Ear, Nose and Throat Surgery, Oxford University Hospitals, Oxford, UK
| | | | - Allyson Parry
- Department of Neurology, Oxford University Hospitals, Oxford, UK
| | - Jane Halliday
- Department of Neurosurgery, Oxford University Hospitals, Oxford, UK
| | - Samuel Mackeith
- Department of Ear, Nose and Throat Surgery, Oxford University Hospitals, Oxford, UK
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Evans DG, Halliday D, Obholzer R, Afridi S, Forde C, Rutherford SA, Hammerbeck-Ward C, Lloyd SK, Freeman SM, Pathmanaban ON, Thomas OM, Laitt RD, Stivaros S, Kilday JP, Vassallo G, McBain C, Lavin T, Paterson C, Whitfield G, McCabe MG, Axon PR, Halliday J, Mackeith S, Parry A, Harkness EF, Buttimore J, King AT. Radiation treatment of benign tumours in NF2-related-schwannomatosis: a national study of 266 irradiated patients showing a significant increase in malignancy/malignant progression. Neurooncol Adv 2023; 5:vdad025. [PMID: 37051330 PMCID: PMC10084499 DOI: 10.1093/noajnl/vdad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
Abstract
Abstract
Background
Radiation treatment of benign tumours in tumour-predisposition syndromes is controversial, but short-term studies from treatment centres suggests safety despite apparent radiation associated malignancy being reported. We determined whether radiation treatment in NF2-related-schwannomatosis patients is associated with increased rates of subsequent malignancy-(M)/malignant progression-(MP).
Methods
All UK patients with NF2 were eligible if they had a clinical/molecular diagnosis. Cases were NF2 patients treated with radiation for benign tumours. Controls were matched for treatment location with surgical/medical treatments based on age and year of treatment. Prospective data collection began in 1990 with addition of retrospective cases to 1969. Kaplan-Meier analysis was performed for malignancy incidence and survival. Outcomes were CNS M/MP (2cm annualised diameter growth) and survival from index tumour treatment.
Results
1345 NF2 patients, 266 (133-Male) underwent radiation treatments between 1969-2021 with median first radiotherapy aged 32.9-(IQR=22.4-46.0). Nine subsequent CNS malignancies/malignant progressions were identified in cases with only four in 1079 untreated-(p<0.001). Lifetime and 20-year CNS M/MP was ~6% in all irradiated patients-(4.9% for VS radiotherapy) versus <1% in the non-irradiated population-(p<0.001/0.01). Controls were well-matched for age at NF2 diagnosis and treatment-(Males=133-50%) and had no M/MP in the CNS post index-tumour treatment-(p=0.0016). Thirty-year survival from index tumour treatment was 45.62%-(95%CI=34.0–56.5) for cases and 66.4%-(57.3–74.0) for controls-(p=0.02), but was non-significantly worse for VS radiotherapy.
Conclusion
-NF2 patients should not be offered radiotherapy as first line treatment of benign tumours and should be given a frank discussion of the potential 5% excess absolute risk of M/MP.
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Affiliation(s)
- D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - Dorothy Halliday
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Rupert Obholzer
- Department of ENT, and Neurology, 18 Guy’s and St Thomas’ NHS Trust , London, UK
| | | | - Claire Forde
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Scott A Rutherford
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Charlotte Hammerbeck-Ward
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Simon K Lloyd
- Department of Otolaryngology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Simon M Freeman
- Department of Otolaryngology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Omar N Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health , University of Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - Owen M Thomas
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Roger D Laitt
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Stavros Stivaros
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences , Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, United Kingdom
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust , Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - John-Paul Kilday
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Oxford Road , Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
| | - Grace Vassallo
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Catherine McBain
- The Christie NHS Foundation Trust , Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
| | - Timothy Lavin
- Department of Neurology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
| | - Chay Paterson
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Division of Evolution and Genomic Medicine , University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust, Manchester, UK
| | - Gillian Whitfield
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Oxford Road , Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
- The Christie NHS Foundation Trust , Manchester, UK
| | - Martin G McCabe
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
- The Christie NHS Foundation Trust , Manchester, UK
| | - Patrick R Axon
- Dept of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Jane Halliday
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Samuel Mackeith
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Allyson Parry
- Department of Genomic Medicine, Neurology, Neurosurgery , ENT, Oxford University Hospitals NHS Foundation Trust
| | - Elaine F Harkness
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences , Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, United Kingdom
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester Universities NHS Foundation Trust , Wythenshawe, Manchester, UK
| | - Juliette Buttimore
- Dept of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust , University of Manchester, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health , University of Manchester, UK
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Shrivastava M, Abdul-Hamid A, Zilani G, Qureishi A, Jeyaretna S, Mackeith S. Assessing the risk of magnetic interaction between auditory implants and programmable ventriculoperitoneal shunts. Cochlear Implants Int 2023; 24:83-86. [PMID: 36647577 DOI: 10.1080/14670100.2023.2166602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This study investigated whether the magnetic field of the internal magnet of cochlear implants and bone-anchored hearing aids (BAHA) would be sufficient to affect a programmable ventriculoperitoneal (VP) shunt. Current guidelines suggest against implanting these hearing devices ipsilateral to a programmable VP shunt, but the exact nature of the interaction has not been quantified. METHODS The magnetic field strength (mT) was measured at 0 and 10 mm from the edge of both the Cochlear Implant CI512 (Cochlear Corporation) magnet and BAHA Attract magnet. Next, the hearing devices were placed into their anatomical positions in a 3-D clay model, along with three different types of programmable VP shunts. The valve setting was measured before and after exposure. RESULTS At 10 mm, neither device generated a magnetic field sufficient to adjust the VP shunt valve. In the clay model, the valve settings were not affected by the presence of any device. CONCLUSION Neither the cochlear implant nor the BAHA subcutaneous internal magnets generated sufficient magnetic field to reprogramme the valves of commonly used programmable VP shunts. The magnetic field from each device decreases dramatically at 10 mm. Further clinical studies to help mitigate the current restrictive guidance should consider involvement of VP shunt manufacturers to inform future shunt development and design.
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Affiliation(s)
- Manu Shrivastava
- Department of Ear Nose and Throat Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ayeshah Abdul-Hamid
- Department of Ear Nose and Throat Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Gulam Zilani
- Department of Neurosurgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ali Qureishi
- Department of Ear Nose and Throat Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sanjeeva Jeyaretna
- Department of Neurosurgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Samuel Mackeith
- Department of Ear Nose and Throat Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
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Brown JJ, May A, Crabtree R, Emmanouil B, Halliday D, Parry A, Mackeith S. Alert Cards to improve awareness of an otological emergency. BMJ Open Qual 2021; 10:bmjoq-2019-000906. [PMID: 33632762 PMCID: PMC7908913 DOI: 10.1136/bmjoq-2019-000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Joshua James Brown
- Neurofibromatosis 2 Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anne May
- Neurofibromatosis 2 Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rose Crabtree
- Neurofibromatosis 2 Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Beatrice Emmanouil
- Neurofibromatosis 2 Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dorothy Halliday
- Neurofibromatosis 2 Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Allyson Parry
- Neurofibromatosis 2 Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Samuel Mackeith
- Neurofibromatosis 2 Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK .,Department of ENT, Oxford University Hospitals NHS Trust, Oxford, UK
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Hajioff D, Mackeith S. Otitis externa. BMJ Clin Evid 2010; 2010:0510. [PMID: 21418684 PMCID: PMC3217807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of the ear canal, and is more common in swimmers, humid environments, people with absence of ear wax or with narrow ear canals, hearing-aid users, and after mechanical trauma. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical and prophylactic treatments for otitis externa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review, we present information relating to the effectiveness and safety of the following interventions: oral antibiotics, specialist aural toilet, topical acetic acid drops or spray, topical aluminium acetate drops, topical antibacterials, topical antifungals, topical anti-infective agents, topical corticosteroids, and water exclusion.
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Affiliation(s)
- Daniel Hajioff
- Southmead Hospital, Bristol Royal Hospital for Children, Bristol, UK
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Hajioff D, Mackeith S. Otitis externa. BMJ Clin Evid 2008; 2008:0510. [PMID: 19450296 PMCID: PMC2907945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of the ear canal, and is more common in swimmers, humid environments, people with absence of ear wax or with narrow ear canals, hearing-aid users, and after mechanical trauma. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical and prophylactic treatments for otitis externa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: oral antibiotics, specialist aural toilet, topical acetic acid drops or spray, topical aluminium acetate drops, topical antibacterials, topical antifungals, topical anti-infective agents, topical corticosteroids, and water exclusion.
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Affiliation(s)
- Daniel Hajioff
- Southmead Hospital, Bristol Royal Hospital for Children, Bristol, UK
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