Life Expectancy After Diagnosis of a Vestibular Schwannoma in Patients 70 Years and Older

Abstract

ImportanceOver the past decades, the number of patients, especially in the older adult patient group, diagnosed with vestibular schwannoma (VS) has increased. Assuming that older adult patients have more comorbidities, a longer recovery period after surgery, a higher rate of surgical complications, and a higher mortality rate after VS surgery, a treatment strategy for this group of patients is warranted, based on clinical evidence on postsurgical survival.ObjectiveTo evaluate the survival after diagnosis of a VS in patients 70 years and older, treated with either observation or surgery, and to compare these findings with the life span of an age-matched background population in Denmark.Design, Setting, and ParticipantsThis was a retrospective cohort study of 624 patients 70 years and older diagnosed with VS in Denmark from 1976 to 2016. Since 1976, all patients with a VS have been registered in a national database, which contains 3637 patients. Of the included patients in this study, 477 were treated conservatively with the “wait-and-scan” strategy, and 147 were treated surgically with removal of the tumor. The survival of the patients was compared with a matched background population in Denmark. Data analysis was performed from January 1976 to January 2017.ExposuresSurgery, radiotherapy, or none.Main Outcomes and MeasuresThe main outcome was survival among the patients and compared with the matched background population.ResultsA total of 624 patients were included (317 female patients [50.8%] and 307 male patients [49.2%]). The mean (SD) survival in the observed patients was 9.2 (4.7) years after diagnosis, whereas for the background population, the expected survival was 11 years from the mean age at diagnosis. For the surgically treated patients, the mean (SD) survival was 11.8 (6.6) years, and expected survival was 11 years for the matched background population. The mean (SD) survival was 10.7 (5.5) years in female patients and 8.9 (5.0) years in male patients. There was no significant difference in survival between treatment modalities, irrespective of tumor size.Conclusions and RelevanceIn this cohort study, survival after diagnosis of a VS in patients 70 years and older was similar in the surgical group compared with the age-matched background population. In the wait-and-scan group, the survival after diagnosis was marginally shorter, which may be associated with increased comorbidity.

Vestibular Schwannoma Surgery in the Ninth Decade of Life: a case series

“…However, some authors challenge this notion, reporting similar rates of severe complications, morbidity, and mortality after neurosurgery in this population compared to matched controls. [14,28,29] According to the French National Institute of Statistic and Economic Studies, in 2016, the life expectancy of an 83 year-old patient in France was 9 years for women and 7 years for men. [49] Therefore, age alone should not serve as a contraindication for VS surgery.…”