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The Changing Landscape of Vestibular Schwannoma Management in the United States--A Shift Toward Conservatism.
Carlson, Matthew L; Habermann, Elizabeth B; Wagie, Amy E; Driscoll, Colin L; Van Gompel, Jamie J; Jacob, Jeffrey T; Link, Michael J.
Afiliación
  • Carlson ML; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA carlson.matthew@mayo.edu.
  • Habermann EB; Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
  • Wagie AE; Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
  • Driscoll CL; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
  • Van Gompel JJ; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
  • Jacob JT; Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
  • Link MJ; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
Otolaryngol Head Neck Surg ; 153(3): 440-6, 2015 Sep.
Article en En | MEDLINE | ID: mdl-26129740
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 mean incidence was approximately 1.1 per 100,000 per year and did not vary significantly across time; however, from 2004 to 2011, there was a statistically significant decrease in tumor size category at time of diagnosis (P < .01). Overall, 3982 patients (48%) received primary microsurgery, 1978 (24%) radiation therapy alone, and 2370 (29%) observation. Within the microsurgical cohort, 732 (18%) underwent subtotal resection, and of those, 98 (13.4%) received postoperative radiation therapy. Multivariable regression revealed that surgical treatment was more common in younger patients and larger tumor size categories (P < .05). Management trend analysis revealed that microsurgery was used less frequently over time (P < .0001), observation was used more frequently (P < .0001), and the pattern of radiation therapy remained unchanged. Linear regression was used to create an equation that was applied to predict future management practices. These data predict that by 2026, half of all cases of VS will be managed initially with observation. CONCLUSION: While the incidence of VS has remained steady, tumor size at time of diagnosis has decreased over time. Within the United States there has been a clear, recent evolution in management toward observation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neuroma Acústico Tipo de estudio: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Otolaryngol Head Neck Surg Asunto de la revista: OTORRINOLARINGOLOGIA Año: 2015 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neuroma Acústico Tipo de estudio: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Otolaryngol Head Neck Surg Asunto de la revista: OTORRINOLARINGOLOGIA Año: 2015 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido