Conservative management of vestibular schwannoma: Predictors of growth and hearing

Daniel Jethanamest, Andrew M. Rivera, Hongzhao Ji, Venkatakarthikeyan Chokkalingam, Fred F. Telischi, Simon I. Angeli

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss. Study Design Retrospective review. Methods A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed. Results A total of 94 patients met inclusion criteria. While undergoing observation, 22.3% of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3% observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1% of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95% confidence interval, 1.03-8.50; P=0.04) for tumor growth. Conclusion Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth. Level of Evidence 4. Laryngoscope, 125:2163-2168, 2015

Original languageEnglish (US)
Pages (from-to)2163-2168
Number of pages6
JournalLaryngoscope
Volume125
Issue number9
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

Fingerprint

Acoustic Neuroma
Hearing
Growth
Observation
Neoplasms
Survival Analysis
Odds Ratio
Neurofibromatosis 2
Laryngoscopes
Conservative Treatment
International Classification of Diseases
Hearing Loss
Tertiary Care Centers
Radiotherapy
Retrospective Studies
Logistic Models
Regression Analysis
Confidence Intervals

Keywords

  • acoustic neuroma
  • conservative management
  • cranial nerve
  • disequilibrium
  • hearing loss
  • imbalance
  • observation
  • tumor
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Jethanamest, D., Rivera, A. M., Ji, H., Chokkalingam, V., Telischi, F. F., & Angeli, S. I. (2015). Conservative management of vestibular schwannoma: Predictors of growth and hearing. Laryngoscope, 125(9), 2163-2168. https://doi.org/10.1002/lary.25159

Conservative management of vestibular schwannoma : Predictors of growth and hearing. / Jethanamest, Daniel; Rivera, Andrew M.; Ji, Hongzhao; Chokkalingam, Venkatakarthikeyan; Telischi, Fred F.; Angeli, Simon I.

In: Laryngoscope, Vol. 125, No. 9, 01.09.2015, p. 2163-2168.

Research output: Contribution to journalArticle

Jethanamest, D, Rivera, AM, Ji, H, Chokkalingam, V, Telischi, FF & Angeli, SI 2015, 'Conservative management of vestibular schwannoma: Predictors of growth and hearing', Laryngoscope, vol. 125, no. 9, pp. 2163-2168. https://doi.org/10.1002/lary.25159
Jethanamest D, Rivera AM, Ji H, Chokkalingam V, Telischi FF, Angeli SI. Conservative management of vestibular schwannoma: Predictors of growth and hearing. Laryngoscope. 2015 Sep 1;125(9):2163-2168. https://doi.org/10.1002/lary.25159
Jethanamest, Daniel ; Rivera, Andrew M. ; Ji, Hongzhao ; Chokkalingam, Venkatakarthikeyan ; Telischi, Fred F. ; Angeli, Simon I. / Conservative management of vestibular schwannoma : Predictors of growth and hearing. In: Laryngoscope. 2015 ; Vol. 125, No. 9. pp. 2163-2168.
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abstract = "Objective To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss. Study Design Retrospective review. Methods A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed. Results A total of 94 patients met inclusion criteria. While undergoing observation, 22.3{\%} of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3{\%} observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1{\%} of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95{\%} confidence interval, 1.03-8.50; P=0.04) for tumor growth. Conclusion Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth. Level of Evidence 4. Laryngoscope, 125:2163-2168, 2015",
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N2 - Objective To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss. Study Design Retrospective review. Methods A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed. Results A total of 94 patients met inclusion criteria. While undergoing observation, 22.3% of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3% observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1% of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95% confidence interval, 1.03-8.50; P=0.04) for tumor growth. Conclusion Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth. Level of Evidence 4. Laryngoscope, 125:2163-2168, 2015

AB - Objective To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss. Study Design Retrospective review. Methods A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed. Results A total of 94 patients met inclusion criteria. While undergoing observation, 22.3% of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3% observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1% of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95% confidence interval, 1.03-8.50; P=0.04) for tumor growth. Conclusion Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth. Level of Evidence 4. Laryngoscope, 125:2163-2168, 2015

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