Neurotological Complications After Radiosurgery Versus Conservative Management in Acoustic Neuromas: A Systematic Review-based Study

Shin, Young Je; Lapeyre‐Mestre, Maryse; Gafsi, Inthidar; Cognard, Christophe; Déguine, Olivier; Trémoulet, M; Fraysse, Bernard

doi:10.1081/0036554021000028084

Cited by 36 publications

(21 citation statements)

References 15 publications

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“…Whereas meta-analyses have reported rates of facial and trigeminal neuropathy up to 19% and 16%, more recent studies have shown mean rates of 1.5% and 1.2%, respectively. 2,17,22,32,38,44,57 This is most likely due to advances in radiotherapy, which have allowed for the use of lower doses and a more accurate dose conformality. 13 Hydrocephalus may occur in up to 4.4% of patients.…”

Section: Discussionmentioning

confidence: 99%

Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management

Babu

Sharma

Bagley

et al. 2013

JNS

159

158

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Object There are a variety of treatment options for the management of vestibular schwannomas (VSs), including microsurgical resection, radiotherapy, and observation. Although the choice of treatment is dependent on various patient factors, physician bias has been shown to significantly affect treatment choice for VS. In this study the authors describe the current epidemiology of VS and treatment trends in the US in the modern era. They also illustrate patient and tumor characteristics and elucidate their effect on tumor management. Methods Patients diagnosed with VS were identified through the Surveillance, Epidemiology, and End Results database, spanning the years 2004–2009. Age-adjusted incidence rates were calculated and adjusted using the 2000 US standard population. The chi-square and Student t-tests were used to evaluate differences between patient and tumor characteristics. Multivariate logistic regression was performed to determine the effects of various patient and tumor characteristics on the choice of tumor treatment. Results A total of 6225 patients with VSs treated between 2004 and 2009 were identified. The overall incidence rate was 1.2 per 100,000 population per year. The median age of patients with VS was 55 years, with the majority of patients being Caucasian (83.16%). Of all patients, 3053 (49.04%) received surgery only, with 1466 (23.55%) receiving radiotherapy alone. Both surgery and radiation were only used in 123 patients (1.98%), with 1504 patients not undergoing any treatment (24.16%). Increasing age correlated with decreased use of surgery (OR 0.95, 95% CI 0.95–0.96; p < 0.0001), whereas increasing tumor size was associated with the increased use of surgery (OR 1.04, 95% CI 1.04–1.05; p < 0.0001). Older age was associated with an increased likelihood of conservative management (OR 1.04, 95% CI 1.04–1.05; p < 0.0001). Racial disparities were also seen, with African American patients being significantly less likely to receive surgical treatment compared with Caucasians (OR 0.50, 95% CI 0.35–0.70; p < 0.0001), despite having larger tumors at diagnosis. Conclusions The incidence of vestibular schwannomas in the US is 1.2 per 100,000 population per year. 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. Racial disparities also exist in the treatment of VSs, with African American patients being half as likely to receive surgery and nearly twice as likely to have their VSs managed conservatively despite presenting with larger tumors. Further studies are needed to elucidate the reasons for treatment disparities and investigate the nationwide trend of resection for the treatment of small VSs.

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Section: Discussionmentioning

confidence: 99%

Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management

Babu

Sharma

Bagley

et al. 2013

JNS

159

158

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“…In fact, there have been no prospective trials comparing radiosurgical treatment of acoustic neuromas with conservative management, leading to the difficulty of determining what the effect of treatment with maximal marginal doses of 12 to 13 Gy really is. Additionally, there has been only one retrospective article comparing the growth patterns of acoustic neuromas managed conservatively with the growth patterns of acoustic neuromas after radiosurgery; however, this article did not discuss the radiation doses administered (8).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Growth Patterns of Acoustic Neuromas With and Without Radiosurgery

Battaglia¹,

Mastrodimos²,

Cueva³

2006

Otology &Amp; Neurotology

112

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Objective: To compare the natural history of acoustic neuroma growth to the reported growth rate of acoustic neuromas after radiosurgical therapy, a retrospective review and a metaanalysis of the literature was performed. The retrospective review was of one hundred eleven patients (average age, 71 yr) who chose to have their acoustic neuromas manage conservatively in our institution. These patients underwent serial magnetic resonance imaging for assessment of tumor growth for an average period of 38 months. Growth patterns if these untreated tumors were compared to that of radiosurgically treated acoustic neuromas reported in the literature. Data Sources: The English-language literature on the topic was searched systematically by Medline and Pubmed using the following key words: acoustic neuroma, vestibular schwannoma, conservative management, conservative treatment, nonsurgical, age, elderly, growth, obervation, untreated, radiosurgery, gamma knife, 13 Gy and 12 Gy. There were no limits to the year of publication. Study Selection: Articles that fulfilled inclusion criteria (methods) were studied in detail. Data Extraction: All the articles described in the study selection were used in the review. Conclusion:The average growth rate of the untreated tumors was 0.7 T 1.4 mm/yr. Eighty-two percent grew less than 1 mm/yr, whereas 18% grew equal to or more than 1 mm/yr. Thirteen percent grew more than 2 mm/yr, with growth being noted at an average of 2.2 years after diagnosis. This represents an 87% control rate if tumor control rate is defined as less than 2-mm growth/yr. Meta-analysis indicates that tumor control rates range in the radiosurgical literature from 86% to 100%. The mean follow-up periods in the radiosurgical literature are generally not reported. Tumor control is not uniformly defined. Based on the result of this study, there is no discernable significant difference between growth patterns of untreated acoustic neuromas and those treated radiosurgically. To establish a significant difference, longer-term follow-up studies with larger sample sizes and tumor control rates are needed. Tumor control should be defined as zero growth. Key Words: Acoustic neuromaVVestibular SchwannomaVRadiosurgeryVGamma knifeVConservative managementVConservative treatmentV 12 GyV13 Gy.

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“…31,32 In particular, stereotactic radiosurgery for the treatment of VS introduces radiation toxicity risks to adjacent neurologic structures and result in a functional threat to the facial nerve, hearing and balance. 14,16,17,23,27,30,[33][34][35][36][37][38][39][40][41] Hydrocephalus and other cranial neuropathies such as facial spasm have also been noted after radiosurgery for VS. 4,5,23,37,[42][43][44][45][46][47] Surgical shunting and cerebrospinal fluid diversion may be required to address the late hydrocephalus complication. 4,5,23,47,48 Despite the availability of published data that highlights the clinical, radiographic, and biological parameters when managing VS patients with radiosurgery, predicting hearing preservation after radiosurgery remains a challenge for practitioners.…”

Section: Introductionmentioning

confidence: 99%

Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: A systematic review

Yang

Aranda

Han

et al. 2009

Journal of Clinical Neuroscience

130

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Neurotological Complications After Radiosurgery Versus Conservative Management in Acoustic Neuromas: A Systematic Review-based Study

Cited by 36 publications

References 15 publications

Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management

Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management

Comparison of Growth Patterns of Acoustic Neuromas With and Without Radiosurgery

Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: A systematic review

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