Association of extent of resection on recurrence-free survival and functional outcome in vestibular schwannoma of the elderly

Frontiers in Oncology

Oncology

Marcos Tatagiba¹  Sophie Shih-Yüng Wang¹  Georgios Naros¹  Kathrin Machetanz¹  Florian Ebner² 

[1] Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, Tübingen, Germany;Department of Neurosurgery, Alfried Krupp Hospital, Essen, Germany;

关键词: acoustic neuroma;    neuro-oncology;    skull base;    geriatric;    elderly;    vestibular schwannoma;   

DOI  :  10.3389/fonc.2023.1153698

 received in 2023-01-30, accepted in 2023-05-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundDespite the ongoing debate on the risk–benefit ratio of vestibular schwannoma (VS) treatment options, watchful observation and radiation are usually favored in the elderly (>65 years). If surgery is inevitable, a multimodal approach after deliberate subtotal resection has been described as a valid option. The relationship between the extent of resection (EOR) of surgical and functional outcomes and recurrence-free survival (RFS) remains unclear. This present study aims to evaluate the functional outcome and RFS of the elderly in relation to the EOR.MethodsThis matched cohort study analyzed all consecutive elderly VS patients treated at a tertiary referral center since 2005. A separate cohort (<65 years) served as a matched control group (young). Clinical status was assessed by the Charlson Comorbidity Index (CCI), the Karnofsky Performance (KPS), and the Gardner and Robertson (GR) and House & Brackmann (H&B) scales. RFS was evaluated by Kaplan–Meier analysis using contrast-enhanced magnetic resonance imaging to identify tumor recurrence.ResultsAmong 2,191 patients, 296 (14%) patients were classified as elderly, of whom 133 (41%) were treated surgically. The elderly were characterized by a higher preoperative morbidity and worse gait uncertainty. Postoperative mortality (0.8% and 1%), morbidity (13% and 14%), and the functional outcome (G&R, H&B, and KPS) did not differ between the elderly and the young. There was a significant benefit in regard to the preoperative imbalance. Gross total resection (GTR) was accomplished in 74% of all cases. Lower grades of the EOR (subtotal and decompressive surgery) raised the incidence of recurrence significantly. Mean time to recurrence in the surgELDERLY was 67.33 ± 42.02 months and 63.2 ± 70.98 months in the surgCONTROL.ConclusionsSurgical VS treatment aiming for complete tumor resection is feasible and safe, even in advanced age. A higher EOR is not associated with cranial nerve deterioration in the elderly compared to the young. In contrast, the EOR determines RFS and the incidence of recurrence/progression in both study cohorts. If surgery is indicated in the elderly, GTR can be intended safely, and if only subtotal resection is achieved, further adjuvant therapy, e.g., radiotherapy, should be discussed in the elderly, as the incidence of recurrence is not significantly lower compared to the young.

【 授权许可】

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Copyright © 2023 Wang, Machetanz, Ebner, Naros and Tatagiba