Changing trends in management of vestibular schwannoma: A National Cancer Database study

被引:15
作者
Bashjawish, Bassel [1 ]
Kilic, Suat [1 ,5 ]
Baredes, Soly [1 ]
Eloy, Jean Anderson [1 ,2 ,3 ,4 ]
Liu, James K. [3 ]
Ying, Yu-Lan Mary [1 ]
机构
[1] Rutgers New Jersey Med Sch, Dept Otolaryngol Head & Neck Surg, 90 Bergen St,Suite 8100, Newark, NJ 07103 USA
[2] Rutgers New Jersey Med Sch, Neurol Inst New Jersey, Ctr Skull Base & Pituitary Surg, Newark, NJ USA
[3] Rutgers New Jersey Med Sch, Dept Neurol Surg, Newark, NJ USA
[4] Rutgers New Jersey Med Sch, Dept Ophthalmol & Visual Sci, Newark, NJ USA
[5] Cleveland Clin, Dept Otolaryngol Head & Neck Surg, Cleveland, OH 44106 USA
基金
美国国家卫生研究院;
关键词
Vestibular schwannoma; stereotactic radiosurgery; microsurgery; National Cancer Database; ACOUSTIC NEUROMA; DISPARITIES; EPIDEMIOLOGY;
D O I
10.1002/lary.27568
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Objective To describe changes in management trends of vestibular schwannoma (VS) and the effects of median income, education level, insurance status, and tumor size on receipt of treatment. Methods Cross-sectional analysis using the National Cancer Database from 2004 to 2014. All patients with a diagnosis of VS were identified between 2004 and 2014. Trends in treatment modality over time were analyzed. Correlation between demographics, institution type, median income, education level, and insurance status were assessed using univariate and multivariate logistic regressions. Results Of the 22,290 VS patients identified, 16,011 (71.8%) received treatment, whereas 6,279 (28.2%) received observation. Management trend analysis over the 11-year period revealed patients with tumor size < 1 cm are more frequently observed (34.6% of cases in 2004 vs. 60.8% of cases in 2014) and less frequently received surgery (34.6% vs. 16.8%). Multivariate analysis showed observation was more frequently used in patients >= 65 years; black patients; and those on Medicaid, Medicare, and noninsured (P < 0.0001). All tumors > 2 cm were more likely to be treated with surgery, specifically subtotal resections (P < 0.0001). Patients treated at nonacademic centers were more likely to receive linear accelerator, or LINAC (Accuray Incorporated, Sunnyvale, CA) therapy than Gamma Knife (Elekta, Stockholm, Sweden) (P < 0.0001). Conclusion Management of VS is shifting toward increased observation, most significantly in tumors size < 1 cm. Insurance provider plays a significant role on receipt of treatment and modality, whereas income and education do not. Level of Evidence NA Laryngoscope, 129:1197-1205, 2019
引用
收藏
页码:1197 / 1205
页数:9
相关论文
共 11 条
[1]   Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management Clinical article [J].
Babu, Ranjith ;
Sharma, Richa ;
Bagley, Jacob H. ;
Hatef, Jeffrey ;
Friedman, Allan H. ;
Adamson, Cory .
JOURNAL OF NEUROSURGERY, 2013, 119 (01) :121-130
[2]   The Changing Landscape of Vestibular Schwannoma Management in the United StatesA Shift Toward Conservatism [J].
Carlson, Matthew L. ;
Habermann, Elizabeth B. ;
Wagie, Amy E. ;
Driscoll, Colin L. ;
Van Gompel, Jamie J. ;
Jacob, Jeffrey T. ;
Link, Michael J. .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2015, 153 (03) :440-446
[3]   Racial, ethnic and socioeconomic disparities in the treatment of brain tumors [J].
Curry, William T., Jr. ;
Barker, Fred G., II .
JOURNAL OF NEURO-ONCOLOGY, 2009, 93 (01) :25-39
[4]   Current epidemiology and management trends in acoustic neuroma [J].
Gal, Thomas J. ;
Shinn, Jennifer ;
Huang, Bin .
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, 2010, 142 (05) :677-681
[5]   Paradoxical trends in the management of vestibular schwannoma in the United States Clinical article [J].
Lau, Tsz ;
Olivera, Raul ;
Miller, Timothy, Jr. ;
Downes, Katheryne ;
Danner, Christopher ;
van Loveren, Harry R. ;
Agazzi, Siviero .
JOURNAL OF NEUROSURGERY, 2012, 117 (03) :514-519
[6]  
LEKSELL L, 1971, ACTA CHIR SCAND, V137, P763
[7]  
Machinis Theofilos G, 2005, Neurosurg Focus, V18, pe9
[8]   Impact of insurance status and race on receipt of treatment for acoustic neuroma: A national cancer database analysis [J].
McClelland, Shearwood, III ;
Kim, Ellen ;
Murphy, James D. ;
Jaboin, Jerry J. .
JOURNAL OF CLINICAL NEUROSCIENCE, 2017, 42 :143-147
[9]   Operative Mortality Rates of Acoustic Neuroma Surgery: A National Cancer Database Analysis [J].
McClelland, Shearwood, III ;
Kim, Ellen ;
Murphy, James D. ;
Jaboin, Jerry J. .
OTOLOGY & NEUROTOLOGY, 2017, 38 (05) :751-753
[10]   Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era [J].
McClelland, Shearwood, III ;
Guo, Hongfei ;
Okuyemi, Kolawole S. .
NEURO-ONCOLOGY, 2011, 13 (11) :1252-1259