Vestibular schwannoma (acoustic neuroma): lines of therapy
4 standard-of-care settings across 2 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | NF2-related schwannomatosis, progressive tumour or falling hearing | Bevacizumab (off label, phase 2 evidence) to shrink tumours and improve hearing; brigatinib on INTUITT-NF2 evidence; hearing rehabilitation with cochlear or auditory brainstem implants; surgery and radiosurgery used selectively. | NCI PDQ; NF2 consensus guidance | 98 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Small tumour, stable or good hearing | Observation with MRI and audiometry, typically yearly; treatment on documented growth or hearing decline. | NCCN Guidelines: Central Nervous System Cancers | 63 | |
| All comers | Growing small or medium tumour | Stereotactic radiosurgery (Gamma Knife, CyberKnife or linac) at about 12 to 13 Gy, or fractionated stereotactic radiotherapy; microsurgery in younger patients or by preference. | NCCN Guidelines: Central Nervous System Cancers | 93 | |
| All comers | Large tumour with brainstem compression or hydrocephalus | Microsurgical resection with facial nerve monitoring, sometimes deliberately subtotal followed by radiosurgery to the remnant; shunting for hydrocephalus. | NCCN Guidelines: Central Nervous System Cancers | 40 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.