The Changing Landscape of Vestibular Schwannoma Management in the United States—A Shift Toward Conservatism

@article{Carlson2015TheCL,
  title={The Changing Landscape of Vestibular Schwannoma Management in the United States—A Shift Toward Conservatism},
  author={Matthew L. Carlson and Elizabeth B. Habermann and Amy E. Wagie and Colin L. W. Driscoll and Jamie J. Van Gompel and Jeffrey T. Jacob and Michael J. Link},
  journal={Otolaryngology–Head and Neck Surgery},
  year={2015},
  volume={153},
  pages={440 - 446}
}
Objective To characterize the evolving management of vestibular schwannoma (VS) in the United States. Study Design Retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database. Setting SEER database. Subjects and Methods All patients with a diagnosis of VS were analyzed. Data were described and compared using trend analyses and univariate and multivariable logistic regression. Results A total of 8330 patients (average age 54.7 years, 51.9% female) were analyzed. The… 

Figures and Tables from this paper

An Update on Epidemiology and Management Trends of Vestibular Schwannomas.
TLDR
The overall incidence of VS is 1.4 per 100,000 per year and has remained relatively stable and there is a trend toward more conservative management with observation, which may be secondary to earlier diagnosis given widespread use of magnetic resonance imaging.
Recent Trends in Vestibular Schwannoma Management: An 11-Year Analysis of the National Cancer Database
TLDR
Although surgery remained the most common treatment modality in the United States, there was a strong shift in the management of VS away from primary surgery and radiation and toward a “wait-and-scan” approach.
Surgical Management of Vestibular Schwannoma: Practice Pattern Analysis via NSQIP
TLDR
There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.
National Trends in Surgical Resection of Vestibular Schwannomas
  • Yin Ren, Rosh K V Sethi, K. Stankovic
  • Medicine
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 2020
TLDR
VS resection has evolved in the United States and while the incidence remained stable, surgical volume decreased by 36%, and hospital charges more than doubled, more cases are being performed at smaller hospitals.
Morbidity of Vestibular Schwannomas as Documented by Treating Providers.
  • M. Nuno, B. Ugiliweneza, M. Boakye, A. Monfared
  • Medicine
    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
  • 2019
TLDR
Patients who eventually underwent surgery were reported by their providers to have higher morbidity before and after treatment, compared with radiosurgery group.
Evolution in Management Trends of Sporadic Vestibular Schwannoma in the United States Over the Last Half-century
TLDR
Overall, these data support a progression toward fewer patients treated with microsurgery in recent decades, possibly due to better detection of small and asymptomatic tumors and a greater understanding of the natural history of disease.
Epidemiology of vestibular schwannoma in the United States, 2004–2016
TLDR
V Vestibular schwannomas incidence and prevalence are highest among adults and white non-Hispanics and there was an increase of radiographically confirmed VS over time.
Single Institutional Experience With Observing 564 Vestibular Schwannomas: Factors Associated With Tumor Growth
  • Jacob B. Hunter, D. Francis, D. Haynes
  • Medicine
    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
  • 2016
TLDR
Risk of VS growth is significantly increased among patients who present with larger tumors and who have concomitant disequilibrium, which is the largest series of observed vestibular schwannoma reported in the literature.
Does where you live influence how your vestibular schwannoma is managed? Examining geographical differences in vestibular schwannoma treatment across the United States
The management of small- to medium-sized vestibular schwannoma (VS) remains controversial. Despite a lack of compelling evidence supporting one treatment modality over others, many providers and
...
...

References

SHOWING 1-10 OF 31 REFERENCES
Paradoxical trends in the management of vestibular schwannoma in the United States.
TLDR
Study data demonstrated a shift in the management of small VSs in the US between 2004 and 2007, with microsurgical removal giving way to radiation treatment and the overall rate for observation remaining low and stable.
Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management.
TLDR
Although many studies have demonstrated improved outcomes with the use of radiotherapy for small- to medium-sized VSs, surgery is still the most commonly used treatment modality for these tumors.
Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery.
TLDR
Unless long-term follow-up evaluation shows frequent tumor progression at currently used radiation doses, radiosurgery should be considered the best management strategy for the majority of VS patients.
The Natural History of Vestibular Schwannoma
TLDR
Growth of vestibular schwannomas occurs within the first 5 years after diagnosis in a limited number of tumors, primarily in tumors with an extrameatal extension, and there is no relation between tumor growth and sex or age.
Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas.
TLDR
Based on the current management protocol, patients with VSs enjoy similar QOL throughout the follow-up period after undergoing observation, radiation therapy, or surgery.
VESTIBULAR SCHWANNOMA: SURGERY OR GAMMA KNIFE RADIOSURGERY? A PROSPECTIVE, NONRANDOMIZED STUDY
TLDR
This is the second prospective study to demonstrate better facial nerve and hearing outcomes from GKRS than from open surgery for small- and medium-sized vestibular schwannomas.
True Incidence of Vestibular Schwannoma?
TLDR
After a steady increase over the last 4 decades, the incidence of vestibular schwannomas appears to have peaked and decreased in recent years, stabilizing at about 19 tumors per million per year.
Systematic review of quality of life in the management of vestibular schwannoma
Current epidemiology and management trends in acoustic neuroma
  • T. Gal, J. Shinn, Bin Huang
  • Medicine
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 2010
Comparison of Long-term Quality-of-Life Outcomes in Vestibular Schwannoma Patients
TLDR
Long-term (>5 years) quality-of-life outcomes measured by the PANQOL in vestibular schwannoma patients show no significant differences between stereotactic radiation, observation, and microsurgical intervention.
...
...