Rthp-12. Non-operative Management of Acoustic Neuroma in Geriatric Patients: a Nationwide Cancer Database Analysis
Year: 2016
Type: conference-abstract
Abstract: The in-hospital mortality rate of acoustic neuroma (AN) surgery is 0.5% and increases exponentially with age; consequently non-operative management has gained popularity (McClelland et al., 2011; Lau et al., 2012). Predominant non-operative AN management involves either radiation (fractionated stereotactic radiotherapy or stereotactic radiosurgery) or observation with serial imaging. The nationwide distribution of these two modalities in the geriatric (minimum age 65) AN population has not been examined. The National Cancer Data Base (NCDB) from 2004-2013 identified geriatric AN patients. Multivariable logistic regression characterized patients who received observation and radiation, including variables for patient age, race, sex, income, geographic region, primary payer for care, tumor size, and comorbidities. Of the 11,614 AN patients, 1,725 (14.9%) were geriatric (median 69;range=65-90); 54% were female. Most had Medicare (79%) or private insurance (15%); median tumor size was 2.1 cm. Solitary treatment was administered as radiation (225 patients; 13.0%), observation (147 patients; 8.5%), and surgery (1,285 patients; 74.5%). Patients with private insurance (OR=0.7;95%CI=0.5-1.0;p=0.005) and a Charlson/Deyo score of 1 or 2 (OR=0.5;95%CI=0.4-0.8;p=0.0005) were less likely to receive radiation, while men (OR=1.3;95%CI=1.0-1.7;p=0.03) and patients treated at a comprehensive cancer center (OR=1.4;95%CI=1.0-1.8;p=0.02) were more likely to receive radiation. African-American race (OR=1.5;95%CI=0.9-2.6;p=0.03) predicted increased observation, while a Charlson/Deyo score of 1 or 2 (OR=0.7;95%CI=0.5-1.0;p=0.03) predicted decreased observation. Fifteen percent of the AN population is at least age 65, with surgery by far the most commonly used treatment modality. Male gender and treatment at comprehensive cancer centers (by 40%) independently predicted receipt of radiation, while African-American race (by 50%) independently predicted receipt of observation. Given the proven impact of radiation therapy on local control in AN, and the relatively small proportion of geriatric patients receiving non-operative treatment, there is fertile ground for dissemination of radiation treatment for geriatric AN patients.
Source: Neuro-Oncology
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2589044716