Correlation of MIB-1 INDEX WITH REGROWTH OF VESTIBULAR SCHWANNOMAS.pptx

Correlation of MIB-1 INDEX WITH REGROWTH OF VESTIBULAR SCHWANNOMAS.pptx

1. Correlation of MIB-1 (K i-67) LABELLING INDEX WITH REGROWTH OF VESTIBULAR SCHWANNOMAS Dilip kumar Macharla (DNB-Resident, Neurosurgery) Manas Panigrahi ( MCh . FACS.) Sailaja M * Satish Rao I * Departments of Neurosurgery & * Neuropatholgy Krishna Institute of Medical Sciences, Hyderabad . ISNOCON - 2016

2. Introduction Pre-op 3 months post op

3. No clear consensus on when to give radiation in residual tumors following vestibular schwannoma excision We tried to study factors which can predict regrowth of residual tumors and analyse their clinical relevance .

4. Objective To study correlation of MIB-1 (Ki-67) labelling index with the regrowth of vestibular schwannomas

5. Methods Study center – KIMS, Hyderabad Duration – from January 2010 to December 2015 Retrospective study 229 vestibular schwannomas are operated .

6. Included 144 – patients selected Histologically proven, unilateral , primary vestibular schwannomas Have minimum follow up of 24 months.

7. Excluded Patients with bilateral tumors, and NF-2 association Patients operated for schwannomas that recurred after surgery or radiation Patients who received radiation immediate post op for residual tumors.

8. All tumors excised through Retromastoid suboccipital approach, with facial nerve (NIM) monitoring

9. Gross total resection attempted in all cases Near total or subtotal resection done when excision is limited by tumor adherent to brainstem, VII/VIII nerve complex or NIM monitor changes and highly vascular tumors

10. All patients followed up with serial imaging 3 months , 1 year and 2 years after surgery. Patients are divided into 2 groups according to changes in the post op imaging Group1 : Radiologically stable group. No recurrence or regrowth of tumor noted in serial imaging Group 2 : Tumors with growth or recurrence in serial imaging

11. Patients in which tumors are growing are referred for radiosurgery Correlation of MIB-1 index of vestibular schwannomas with their growth / recurrence after surgery is studied. Other clinical, radiological factors are compared in the Group 1 and Group 2 , their significance in is studied

12. Results Study Period Jan 2010 to Dec 2015 Duration 72 months Total VESTIBULAR SCHWANNOMAS OPERARTED 228 Minimum Follow up 24 Months Tumor included in the study 144

13. Demographic data Patients included in the study 144 Mean duration of follow –up 38 ± 10.1 months Male 77 Female 67 Right 70 Left 74 Mean Age 43.94 ± 12.87 years Mean tumor size 40.5 ± 7.13 mm Mean MIB-1 index 2.26 ± 2.7

14. Totality of Resection Total = 144 % Definitions * Gross Total Resection (GTR) 52 36.11 % Total Macro scopic Tumor Excision Near Total Resection (NTR) 81 56.25 % Part of tumor adherent to facial nerve/ brain stem left behind Sub Total Resection (STR) 11 7.64 % < 95 % tumor excised * Reference : Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation ; Ho Jun SEOL – et al, Neurologia medico- chirurgica Vol. 46 (2006) No. 4 P 176-181 Totality of Resection

15. Patients included in the study 144 Mean duration of follow –up 38 ± 10.1 months Group -1 ( Radiologically stable) (87.5% ) Group -2 ( Tumor growth ) 18 (12.5%)

16. Correlation of MIB-1 index Group 1 Group 2 ‘ p’ Value Stable Growing No of cases 126 18 Mean follow up 37.9 ± 10.3 months 38.4 ± 8.6 months MIB-1 index 1.85 ± 1.45 4.78 ± 5.78 p = 0.023 Median duration for recurrence / growth 34.5 months

17. Correlation of MIB-1 index Group 1 Group 2 ‘ p’ Value Stable Growing No of cases 126 18 Mean follow up 37.9 ± 10.3 months 38.4 ± 8.6 months MIB-1 index 1.85 ± 1.45 4.78 ± 5.78 p = 0.023 Median duration for recurrence / growth 34.5 months

18. ROC curve MIB-1 cut off – 3 %

19. Other factors Group 1 Group 2 ‘ p’ Value Stable Growing No of cases 126 18 Male : Female 7 : 11 70 : 56 p = 0.213 Age (years) 44.19 ± 13.03 42.2 ± 11.8 p = 0.26 Tumor size 39.8 ± 6.9 mm 42.8 ± 7.2 mm p = 0.115 Totality of resection Total (Vs) Subtotal resection P = 0.055 Cystic change ?

20. Growth Stable SOLID 13 114 CYSTIC 5 12 P =

21. Discussion

22. Conclusions Higher MIB-1 index is associated with recurrence of vestibular schwannomas after microsurgical excision . Early radiosurgery can be recommended for tumors with higher MIB-1 index (≥ 3%), in residual tumors, instead of follow-up with serial imaging and radiosurgery upon regrowth.

23. MIB-1 index 14% Pre-op 3 months post op 15 months post op

24. MIB-1 index : 1% Pre-op 3 months post op 12 months post op

25. Pre-op 3 months post op 24 months post op MIB-1 index : 1%

26. MIB-1 index - Pre-op 12 months post op 30 months post op

27. MIB-1 index : 1%

28. Growth of Sporadic Vestibular Schwannomas Correlates with Ki­67 Proliferation Index Steinhart , F . Triebswetter, S. Wolf, H. Gress, J. Bohlender, H. Iro

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