Evolution in Management Trends of Sporadic Vestibular Schwannoma from 1970 through 2019 Using the Acoustic Neuroma Association Patient Registry

Background: Limited data currently characterize management trends of sporadic vestibular schwannoma (VS) in the United States over recent decades. Serving as the primary patient support organization in the United States, the Acoustic Neuroma Association (ANA) facilitates amalgamation of patient data from patients treated in 1970 through January, 2019. Objectives: The aim of the study is to characterize the evolution in the management of sporadic VS among ANA survey respondents from 1970 to 2019. Study Design: Cross-sectional survey. Patients: ANA survey respondents diagnosed with sporadic VS. Main Outcome Measures: Trends in rates of microsurgery, radiosurgery, and observation from 1970 to 2019. Results: Among 878 patients with sporadic VS that reported data over the study period, 633 (70%) patients underwent definitive management with either microsurgery or radiosurgery/radiotherapy between 1970 and 2019. The proportion of patients treated with microsurgery gradually increased from 80% (⅘) in the 1970s to a peak of 95% (58/63) by 1989. The proportion of cases treated with microsurgery declined into the 2000s, with approximately 66% (234/356) of patients treated from 2010 to 2019 undergoing microsurgery. Only 56 (6%) patients underwent radiosurgery/radiotherapy over the study period. The proportion of patients treated with radiosurgery/radiotherapy increased from 1970 through the turn of the century, with approximately 17% (22/126) of the patients treated with radiosurgery/radiotherapy from 2000 to 2009. This proportion decreased over the following decade from 2010 to 2019 to 11% (28/249). In total, only 30% of the respondents underwent observation over the study period (245/878). Conclusion: Overall, these data support a progression toward a greater proportion of patients treated with observation over recent decades. However, when compared with population-based data within the United States from the Surveillance, Epidemiology, and End Results database,[ 1 ] it is evident that far more ANA patients are aggressively managed with microsurgery for initial treatment of their tumor. This observation likely stems from the tendency of patients who participate in the ANA to present with more severe disease at time of diagnosis.[ 2 ] [ 3 ]