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Iivanainen A, Raitanen J, Auvinen A. Incidence of vestibular schwannoma in Finland, 1990-2017. Acta Oncol 2024; 63:111-117. [PMID: 38578202 DOI: 10.2340/1651-226x.2024.20352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/06/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND An increasing trend in incidence of vestibular schwannomas (VS) has been reported, though not consistently, across populations. Materials and methods: We obtained data from the Finnish Cancer Registry on 1,149 VS cases diagnosed in 1990-2017 with tabular data up to 2022. We calculated age-standardised incidence rates (ASR) overall, by sex, and for 10-year age groups. We analysed time trends using Poisson and joinpoint regression. RESULTS The average ASR of VS in Finland during 1990-2017 was 8.6/1,000,000 person-years for women and 7.5/1,000,000 for men. A declining trend was found with an average annual percent change of -1.7% (95% confidence interval [CI]: -2.8%, -0.6%) for women, -2.2% (95% CI: -3.6%, -0.7%) for men, and -1.9% (95% CI: -2.9%, -1.0%) for both sexes combined. The ASR in women was 11.6/1,000,000 person-years in 1990 and it decreased to 8.2/1,000,000 by 2017. Correspondingly, the incidence in men was 7.1/1,000,000 in 1990 and decreased to 5.1/1,000,000 by 2017. Some decline in incidence over time was found in all age groups below 80 years, but the decline (2.3-3.1% per year) was statistically significant only in age groups 40-49, 50-59, and 60-69 years. In the oldest age group (80+ years), the incidence of VS increased by 16% per year. For 2018-2022, the ASR was 7.6/1,000,000 for both sexes combined, with a decline by -1.7% (95% CI: -2.3%, -1.2%) annually for the entire period 1990-2022. CONCLUSION In contrast to the increasing incidence reported in some studies, we found a decreasing trend in VS incidence for both sexes in Finland.
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Affiliation(s)
- Aino Iivanainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Jani Raitanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland; UKK Institute for Health Promotion Research, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland; STUK - Radiation and Nuclear Safety Authority, Environmental Surveillance, Vantaa, Finland
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Żurek M, Wojciechowski T, Niemczyk K. Nationwide clinico-epidemiological treatment analysis of adult patients with tumors of cerebellopontine angle and internal acoustic meatus in Poland during 2011-2020. BMC Public Health 2023; 23:1735. [PMID: 37674102 PMCID: PMC10481480 DOI: 10.1186/s12889-023-16551-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE The aim of this study is to report the epidemiologic characteristics of tumors of the cerebellopontine angle (CPAT) and internal acoustic meatus in adult Polish population throughout the second decade of XXI century and to analyze their treatment. MATERIAL AND METHODS A retrospective analysis of patients with cerebellopontine angle (CPA) and internal acoustic meatus tumors diagnosed in Poland in 2011-2020 was performed. Data recorded in the National Health Fund (NHF) database were analyzed. International Classification of Diseases codes (ICD-9 and ICD-10) were used to identify study group patients and treatment procedures. RESULTS From 2011 to 2020 6,173 Polish adult patients were diagnosed with cerebellopontine angle and internal acoustic meatus tumors. The average incidence in Poland is 1.99 per 100,000 residents/year. It mostly affects women (61.64%), and the average age of patients is 53.78 years. The incidence has steadily increased over the past decade. Treatment has changed significantly over the years, with a definite increase in the number of patients treated with radiotherapy (from 0.54 to 19.34%), and a decrease in surgical therapies (from 41.67 to 6.8%). The most common symptoms were vertigo and/or dizziness (43.48%) and sensorineural hearing loss (39.58%). 4.65% of patients suffered from sudden deafness, in this group of patients the risk of CPAT detection was the highest (6.25 / 1000 patients). CONCLUSIONS The total incidence of CPAT and demographic characteristics of patients were comparable to other studies. Our study demonstrated the increased number of patients are being treated with radiotherapy and fewer with microsurgery. Sudden sensorineural hearing loss (SSNHL) is an uncommon manifestation of CPAT but proper diagnosis should be undertaken because the risk of diagnosis such tumors is greater in this group.
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Affiliation(s)
- Michał Żurek
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 1a Banacha St., 02097, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Zwirki and Wigury Str, 02091, Warsaw, Poland
- Department of Analyses and Strategies, Ministry of Health, 15 Miodowa Str, 00952, Warsaw, Poland
| | - Tomasz Wojciechowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 1a Banacha St., 02097, Warsaw, Poland.
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, 1a Banacha St., 02097, Warsaw, Poland
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Veldeman M, Rossmann T, Huhtakangas J, Nurminen V, Eisenring C, Sinkkonen ST, Niemela M, Lehecka M. Three-Dimensional Exoscopic Versus Microscopic Resection of Vestibular Schwannomas: A Comparative Series. Oper Neurosurg (Hagerstown) 2023; 24:507-513. [PMID: 36715988 DOI: 10.1227/ons.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/27/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Microsurgical resection of vestibular schwannoma (VS) is highly challenging, especially because surgical treatment nowadays is mainly reserved for larger (Koos grade 3 and 4) tumors. OBJECTIVE To assess the performance of three-dimensional exoscope use in VS resection in comparison with the operative microscope. METHODS Duration of surgery and clinical and radiological results were collected for 13 consecutive exoscopic schwannoma surgeries. Results were compared with 26 preceding microsurgical resections after acknowledging similar surgical complexity between groups by assessment of tumor size (maximum diameter and Koos grade), the presence of meatal extension or cystic components, and preoperative hearing and facial nerve function. RESULTS Total duration of surgery was comparable between microscopically and exoscopically operated patients (264 minutes ± 92 vs 231 minutes ± 84, respectively; P = .276). However, operative time gradually decreased in consecutive exoscopic cases and in a multiple regression model predicting duration of surgery, and exoscope use was associated with a reduction of 58.5 minutes (95% CI -106.3 to -10.6; P = .018). Tumor size was identified as the main determinant of duration of surgery (regression coefficient = 5.50, 95% CI 3.20-7.80) along meatal extension and the presence of cystic components. No differences in postoperative hearing preservation and facial nerve function were noted between the exoscope and the microscope. CONCLUSION Resection of VS using a foot switch-operated three-dimensional exoscope is safe and leads to comparable clinical and radiological results as resection with the operative microscope.
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Affiliation(s)
- Michael Veldeman
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Tobias Rossmann
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Justiina Huhtakangas
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Saku T Sinkkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Niemela
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Rao P, Thibodeau R, Jafroodifar A, Mangla R. Hypervascular vestibular schwannoma: A case report and review of the literature. Radiol Case Rep 2021; 16:2841-2846. [PMID: 34401010 PMCID: PMC8349915 DOI: 10.1016/j.radcr.2021.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/11/2022] Open
Abstract
Vestibular schwannomas, also known as acoustic neuromas, are benign tumors that arise from Schwann cells near the transition from glial cells to Schwann cells. While most vestibular schwannomas are hypovascular tumors, a small percentage constitute the hemorrhagic and/or hypervascular vestibular schwannomas (HVS) subtype. We describe a case of a 36-year-old female who presented with nausea, vomiting, and an acute decrease in vision in her right eye. Computed tomography of the head demonstrated a hemorrhagic lesion in the right hemisphere with evidence of ventricular effacement. Follow-up magnetic resonance imaging revealed a mass in the right cerebellopontine angle that was hypointense on T1-weighted imaging and mild hyperintense heterogeneous signal on T2-weighted imaging, suggestive of a hemorrhagic vestibular schwannoma. It is important for radiologists to recognize the unique clinical and radiological features of HVS in the initial diagnostic assessment of cerebellopontine angle tumors and to distinguish it from common (hypovascular) vestibular schwannomas and other related pathologies. A preoperative diagnosis of HVS allows clinicians to become familiar with the unique characteristics of the tumor and to devise a feasible operative strategy prior to surgical resection.
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Affiliation(s)
- Priya Rao
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Ryan Thibodeau
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Abtin Jafroodifar
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Rajiv Mangla
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
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Withrow DR, Devesa SS, Deapen D, Petkov V, Van Dyke AL, Adamo M, Armstrong TS, Gilbert MR, Linet MS. Nonmalignant meningioma and vestibular schwannoma incidence trends in the United States, 2004-2017. Cancer 2021; 127:3579-3590. [PMID: 34160068 PMCID: PMC10103813 DOI: 10.1002/cncr.33553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Given concerns about risks associated with the growing use of mobile phones over recent decades, the authors analyzed temporal trends in incidence rates of nonmalignant meningioma and vestibular schwannoma in the United States. METHODS The incidence of nonmalignant meningioma and vestibular schwannoma among adults in the Surveillance, Epidemiology, and End Results 18 registries during 2004 through 2017 was evaluated according to the method of diagnosis: microscopically (MC) or radiographically confirmed (RGC). Annual percent changes (APCs) and 95% CIs were estimated using log-linear models. RESULTS Overall meningioma rates (n = 108,043) increased significantly from 2004 to 2009 (APC, 5.4%; 95% CI, 4.4%-6.4%) but subsequently rose at a slower pace through 2017 (APC, 1.0%; 95% CI, 0.6%-1.5%). Rates for MC meningiomas changed little from 2004 to 2017 (APC, -0.3%; 95% CI, -0.7%, 0.1%) but rose rapidly for RGC meningiomas until 2009 (APC, 9.5%; 95% CI, 7.8%-11.1%) and rose more modestly thereafter (APC, 2.3%; 95% CI, 1.5%-3.0%). Overall vestibular schwannoma rates (n = 17,475) were stable (APC, 0.4%; 95% CI, -0.2%, 1.0%), but MC vestibular schwannoma rates decreased (APC, -1.9%; 95% CI, -2.7%, -1.1%), whereas RGC vestibular schwannoma rates rose (2006-2017: APC, 1.7%; 95% CI, 0.5%-3.0%). For each tumor, the trends by diagnostic method were similar for each sex and each racial/ethnic group, but RGC diagnosis was more likely in older patients and for smaller tumors. Meningioma trends and the proportion of RGC diagnoses varied notably by registry. CONCLUSIONS Overall trends obscured differences by diagnostic method in this first large, detailed assessment, but the recent stable rates argue against an association with mobile phone use. Variation among registries requires evaluation to improve the registration of these nonmalignant tumors. LAY SUMMARY The etiology of most benign meningiomas and vestibular schwannomas is poorly understood, but concerns have been raised about whether mobile phone use contributes to risk of developing these tumors. Descriptive studies examining temporal trends could provide insight; however, globally, few registries collect these nonmalignant cases. In the United States, reporting benign meningiomas and vestibular schwannomas became required by law in 2004. This was the first large, systematic study to quantify and characterize incidence trends for meningioma and vestibular schwannoma according to whether the tumors were diagnosed microscopically or only radiographically. Differential trends across registries and by diagnostic method suggest that caution should be used when interpreting the patterns.
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Affiliation(s)
- Diana R Withrow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Susan S Devesa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Dennis Deapen
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Valentina Petkov
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Alison L Van Dyke
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Margaret Adamo
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Terri S Armstrong
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Mark R Gilbert
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Abstract
OBJECTIVE To determine the current epidemiology and management trends for patients with vestibular schwannomas (VS). STUDY DESIGN Retrospective cohort study. SETTING The Surveillance, Epidemiology, and End Results (SEER) tumor registry. PATIENTS The SEER database was queried to identify patients diagnosed with VS from 1973 to 2015. Demographics, patient and tumor characteristics, and treatment methods were analyzed. RESULTS A total of 14,507 patients with VS were identified. The mean age at diagnosis was 55 ± 14.9 years. Age-adjusted incidence from 2006 to 2015 was 1.4 per 100,000 per year and remained relatively stable. Incidence across age varied with sex, as younger women and older men had increased incidences comparatively. A higher percentage of patients underwent surgery alone (43%), followed by observation (32%), radiation alone (23%), and combined radiation and surgery (2%). Age 65 and older was associated with observation (odds ratio [OR] 1.417; p = 0.029) whereas age 20 to 39 and 40 to 49 were associated with surgery (OR 2.013 and 1.935; p < 0.001). Older age was associated with radiation. Larger tumor size was associated with surgery and combined treatment. African American patients and American Indian or Alaskan Native patients were more likely to undergo observation than surgery. CONCLUSIONS The overall incidence of VS is 1.4 per 100,000 per year and has remained relatively stable. There is a trend toward more conservative management with observation, which may be secondary to earlier diagnosis given widespread use of magnetic resonance imaging. Further studies are necessary to investigate differences in disease patterns and disparities in management.
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Epidemiology and Diagnostic Characteristics of Vestibular Schwannomas-Does Gender Matter? Otol Neurotol 2021; 41:e1372-e1378. [PMID: 33492815 DOI: 10.1097/mao.0000000000002936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A number of epidemiological studies have reported data on, e.g., tumor size and hearing at diagnosis for patients with a vestibular schwannoma (VS), whereas only a few have touched upon the potential significance of sex. The aim of this report is thus to present gender-specific data on incidence and age, tumor localization, tumor size, and hearing loss at diagnosis. MATERIAL AND METHODS Since 1976, various data for all patients diagnosed with a sporadic VS in Denmark have been entered prospectively into a national database. Data on sex, incidence, age, tumor localization, tumor size, and hearing (discrimination) were extracted for the period 1976 to 2015. RESULTS Over the 40 years, 3,637 cases were diagnosed, of which 1,804 were women (50%) and 1,833 men (50%). For both sexes, an increasing incidence of tumors with a steadily decreasing size was found. Age was increasing and hearing at diagnosis was increasingly better.Previously, women had more extrameatal and thus larger tumors. During the most recent decade, more tumors were found in men and hearing at diagnosis was better for women, whereas age and tumor size were comparable. CONCLUSION The data on gender-specific epidemiology and diagnostic characteristics show varying trends over the 40-year-period spanned. For both sexes, an increasing incidence of tumors with a steadily decreasing size was found. Age is increasing and hearing at diagnosis is increasingly better. More extrameatal and thus larger tumors were previously found in women. Contemporarily, more vestibular schwannomas are found in men and diagnostic hearing is better in women.
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Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D, Evans DG, Lefranc F, Sallabanda K, Falini A, Axon P, Sterkers O, Fariselli L, Wick W, Tonn JC. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol 2021; 22:31-45. [PMID: 31504802 DOI: 10.1093/neuonc/noz153] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The level of evidence to provide treatment recommendations for vestibular schwannoma is low compared with other intracranial neoplasms. Therefore, the vestibular schwannoma task force of the European Association of Neuro-Oncology assessed the data available in the literature and composed a set of recommendations for health care professionals. The radiological diagnosis of vestibular schwannoma is made by magnetic resonance imaging. Histological verification of the diagnosis is not always required. Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery. The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center. In small tumors, observation has to be weighed against radiosurgery, in large tumors surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery. Except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy.
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Affiliation(s)
- Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jean Regis
- Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Timone University Hospital, Marseille, France
| | - Morten Lund-Johansen
- Department of Neurosurgery, Bergen University Hospital and Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Pantelis Stavrinou
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine and NW Laboratory Genetics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Florence Lefranc
- Department of Neurosurgery, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - Kita Sallabanda
- Department of Neurosurgery, University Hospital San Carlos, Complutense University of Madrid, Madrid, Spain; University Hospital San Carlos, CyberKnife Centre, Genesiscare Madrid, Madrid, Spain
| | - Andrea Falini
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Patrick Axon
- Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Olivier Sterkers
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull Base Surgery, Public Assistance-Paris Hospital, Pitié-Salpêtrière Group Hospital, Paris, France
| | - Laura Fariselli
- Unit of Radiotherapy, Neurological Institute Carlo Best, Milan, Italy
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery Ludwig-Maximilians University and DKTK partner site, University of Munich, Munich, Germany
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Regional variation in vestibular schwannoma management and patient support group participation across the United States. Am J Otolaryngol 2020; 41:102731. [PMID: 32977061 DOI: 10.1016/j.amjoto.2020.102731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The Acoustic Neuroma Association (ANA) represents the largest existing patient support organization for those diagnosed with vestibular schwannoma (VS) in the United States. Yet, the degree to which the ANA is actually utilized across the country is unknown. Moreover, evidence suggests that there may exist significant regional variation in management practices of VS across the United States. MATERIALS AND METHODS Patient participation in the ANA by state and geographical region, as well as their management approach, was reviewed through a cross-sectional survey performed from February 2017 through January 2019, patients diagnosed with sporadic VS. RESULTS Among 878 patients studied, the District of Columbia had the largest proportion of ANA patients relative to state population (0.85 per 100,000 persons), followed by New Hampshire (0.74), Maine (0.60), and New Jersey (0.42). Comparatively, Mississippi (0.03), Hawaii (0.07), and Rhode Island (0.09) harbored significantly lower participation rates (p = 0.001). Significant treatment variations were observed across the United States: in Maine, Iowa, Missouri, Kansas, and New Hampshire, an average of 73% (range, 70-75) of patients underwent microsurgery, whereas only 24% (range, 0-35) of patients in Colorado, New York, Massachusetts, Connecticut, and West Virginia underwent microsurgery (p < 0.001). After controlling for patient age and tumor size, patients were significantly more likely to undergo a retrosigmoid approach than the translabyrinthine approach for medium- to large-sized tumors in the Northeast (OR = 4.18; p = 0.001) and Western United States (OR = 2.94; p = 0.009). CONCLUSIONS Large regional variation exists surrounding patient participation in the ANA as well as management practices across the United States.
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Carlberg M, Koppel T, Ahonen M, Hardell L. Case-control study on occupational exposure to extremely low-frequency electromagnetic fields and the association with acoustic neuroma. ENVIRONMENTAL RESEARCH 2020; 187:109621. [PMID: 32422481 DOI: 10.1016/j.envres.2020.109621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/08/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) was in 2002 classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO based on an increased risk for childhood leukemia. In case-control studies on brain and head tumours during 1997-2003 and 2007-2009 we assessed life-time occupations in addition to exposure to different agents. The INTEROCC ELF-EMF Job-Exposure Matrix was used for associating occupations with ELF-EMF exposure (μT) with acoustic neuroma. Cumulative exposure (μT-years), average exposure (μT) and maximum exposed job (μT) were calculated. No increased risk for acoustic neuroma was found in any category. For cumulative exposure in the highest exposure category 8.52+ μT years odds ratio (OR) = 1.2, 95% confidence interval (CI) = 0.8-2.0, p linear trend = 0.37 was calculated. No statistically significant risks were found in the time windows 1-14 years, and 15+ years, respectively. In conclusion occupational ELF-EMF was not associated with an increased risk for acoustic neuroma.
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Affiliation(s)
- Michael Carlberg
- The Environment and Cancer Research Foundation, Studievägen 35, SE 702 17, Örebro, Sweden.
| | - Tarmo Koppel
- Department of Labour Environment and Safety, Tallinn University of Technology, SCO351 Ehitajate Tee 5, 19086, Tallinn, Estonia.
| | - Mikko Ahonen
- Institute of Environmental Health and Safety, Jaama 14-3, 11615, Tallinn, Estonia.
| | - Lennart Hardell
- The Environment and Cancer Research Foundation, Studievägen 35, SE 702 17, Örebro, Sweden.
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D’Haese S, Parmentier H, Keppler H, Van Vooren S, Van Driessche V, Bauters W, Van Roost D, Dhooge I. Vestibular schwannoma: natural growth and possible predictive factors. Acta Otolaryngol 2019; 139:753-758. [PMID: 31282832 DOI: 10.1080/00016489.2019.1635268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Prediction of vestibular schwannoma (VS) growth would allow for a more differentiated follow-up protocol. Objectives: The natural course of a VS and predictive factors of growth are investigated. Methods: Sixty-two sporadic VS cases diagnosed between 2003 and 2015 were included in this retrospective cohort study. After initial surveillance, active therapy was initiated in 31/62 patients. Regular magnetic resonance images (MRIs) were performed. Two mm/year linear difference was the cut-off value for significant growth. The STROBE guidelines have been implemented. Results: Growth of the tumor was detected in 56% of patients and mainly observed in the first three years of follow-up. Tumor size remained stable in 34% and decreased in 10% of patients. No baseline information, symptom, or sign was found to be predictive for growth. Conclusions: In 56% of the initially conservatively managed VSs growth was observed and active treatment was initiated. Eighty-seven percent of the growing VSs were identified during the first three years of follow-up. The initially larger VSs seemed to grow faster and needed active treatment earlier during follow-up. No predicting factors for growth identified from the literature could be confirmed in the present study. Serial MRI remains the appropriate method to detect tumor growth.
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Affiliation(s)
- Siska D’Haese
- Department of Oto-rhino-laryngology, Ghent University Hospital, Ghent, Belgium
| | - Heleen Parmentier
- Department of Oto-rhino-laryngology, Ghent University Hospital, Ghent, Belgium
| | - Hannah Keppler
- Department of Oto-rhino-laryngology, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sandrien Van Vooren
- Department of Oto-rhino-laryngology, Ghent University Hospital, Ghent, Belgium
| | | | - Wouter Bauters
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Dirk Van Roost
- Department of Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Oto-rhino-laryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Ghent University, Ghent, Belgium
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Röösli M, Lagorio S, Schoemaker MJ, Schüz J, Feychting M. Brain and Salivary Gland Tumors and Mobile Phone Use: Evaluating the Evidence from Various Epidemiological Study Designs. Annu Rev Public Health 2019; 40:221-238. [PMID: 30633716 DOI: 10.1146/annurev-publhealth-040218-044037] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mobile phones (MPs) are the most relevant source of radiofrequency electromagnetic field (RF-EMF) exposure to the brain and the salivary gland. Whether this exposure implies a cancer risk has been addressed in several case-control and few cohort studies. A meta-analysis of these studies does not show increased risks for meningioma, pituitary, and salivary gland tumors. For glioma and acoustic neuroma, the results are heterogeneous, with few case-control studies reporting substantially increased risks. However, these elevated risks are not coherent with observed incidence time trends, which are considered informative for this specific topic owing to the steep increase in MP use, the availability of virtually complete cancer registry data from many countries, and the limited number of known competing environmental risk factors. In conclusion, epidemiological studies do not suggest increased brain or salivary gland tumor risk with MP use, although some uncertainty remains regarding long latency periods (>15 years), rare brain tumor subtypes, and MP usage during childhood.
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Affiliation(s)
- Martin Röösli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Susanna Lagorio
- Department of Oncology and Molecular Medicine, National Institute of Health, 00161 Rome, Italy
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, United Kingdom
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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Torres Maldonado S, Naples JG, Fathy R, Eliades SJ, Lee JYK, Brant JA, Ruckenstein MJ. Recent Trends in Vestibular Schwannoma Management: An 11-Year Analysis of the National Cancer Database. Otolaryngol Head Neck Surg 2019; 161:137-143. [DOI: 10.1177/0194599819835495] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ObjectiveA better understanding of the natural history of vestibular schwannoma (VS) has resulted in a change in treatment paradigms. It has also been proposed that increased use of high-resolution magnetic resonance imaging has allowed for an increased identification of small tumors. The aim of this study was to evaluate recent trends in the presentation and primary management of VS in the United States.Study DesignRetrospective analysis of the National Cancer Database (NCDB).SettingNCDB database.Subjects and MethodsAll patients with a diagnosis of VS between 2004 and 2014 were included. Data were analyzed with univariable and multivariable logistic regression.ResultsIn total, 28,190 patients (mean age 55 years, 52.9% female) with VS were analyzed. Linear regression showed a small decrease in average tumor size over time (–0.06 mm/year, P = .03). Overall, 11,121 patients (40%) received surgery, 8512 (30%) radiation, and 7686 (27%) observation. Controlling for patient, tumor, and treatment center factors, the odds ratio (OR) for receiving surgery in 2014 was 0.60 (confidence interval [CI], 0.50-0.71) while the OR for receiving radiation was 0.75 (CI, 0.64-0.87) as compared to those diagnosed in 2004. The largest increases in observation rates occurred among tumors ≤2 cm ( P < .001).ConclusionThere was not a clinically significant change in the average tumor size at diagnosis. Although surgery remained the most common treatment modality in the United States, there was a strong shift in the management of VS away from primary surgery and radiation and toward a “wait-and-scan” approach.
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Affiliation(s)
- Solymar Torres Maldonado
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James G. Naples
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramie Fathy
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven J. Eliades
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Y. K. Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason A. Brant
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J. Ruckenstein
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bartek J, Förander P, Thurin E, Wangerid T, Henriksson R, Hesselager G, Jakola AS. Short-Term Surgical Outcome for Vestibular Schwannoma in Sweden: A Nation-Wide Registry Study. Front Neurol 2019; 10:43. [PMID: 30761075 PMCID: PMC6361837 DOI: 10.3389/fneur.2019.00043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Vestibular Schwannoma (VS) is a benign neoplasm arising from the 8th cranial nerve, with surgery one of the treatment modalities. In a nation-wide registry study, we describe the baseline, treatment characteristics, and short-term outcome in patients surgically treated for VS. Methods: We performed a nationwide study with data from the Swedish Brain Tumor Registry (SBTR) for all adults diagnosed with VS 2009–2015. Patient symptoms, tumor characteristics, and postoperative complications were analyzed. Results: In total 348 patients underwent surgery for VS. Mean age was 50.6 ± 14.5 years and 165 patients (47.4%) were female. The most common symptom was focal neurological deficit (92.0%), with only 25 (7.2%) being asymptomatic prior to surgery, and 217 (63.6%) had no restriction in activity. Following surgery, 100 (28.7%) patients developed new deficit(s). In terms of postoperative complications; 11 (3.2%) had a hematoma, 35 (10.1%) an infection, 10 (2.9%) a venous thromboembolism, and 23 (6.6%) had a reoperation due to complication. There were no deaths within 30-days after surgery. When grouped according to tumor size (< 4 vs. ≥4 cm), those with ≥4 cm tumors were more often males (p = 0.02), had more often ICP related symptoms (p = 0.03) and shorter time from imaging to surgery (p < 0.01). Analysis of the younger (< 65 years) vs. elderly (≥65 years) revealed no difference in outcome except increased 1-year mortality (p = 0.002) in elderly. Conclusion: In this nation-wide registry-study, we benchmark the 30-day complication rate after VS surgery as collected by the SBTR. Further, we present the current neurosurgical outcome data from both VS smaller than 40 mm compared to larger tumors, as well as younger vs. elderly VS patients. Since surgical decision making is a careful consideration of short term risk vs. long term benefit, this information can be useful in clinical decision making.
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Affiliation(s)
- Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Petter Förander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Thurin
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Theresa Wangerid
- Department of Neurology, Capio St. Göran Hospital, Stockholm, Sweden
| | - Roger Henriksson
- Regional Cancer Centre Stockholm/Gotland, Stockholm, Sweden.,Department of Radiation Sciences and Oncology, University of Umeå, Umeå, Sweden
| | - Göran Hesselager
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - Asgeir Store Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
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Koo M, Lai JT, Yang EYL, Liu TC, Hwang JH. Incidence of Vestibular Schwannoma in Taiwan from 2001 to 2012: A Population-Based National Health Insurance Study. Ann Otol Rhinol Laryngol 2018; 127:694-697. [PMID: 30032646 DOI: 10.1177/0003489418788385] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Vestibular schwannomas, also known as acoustic neuromas, are slow-growing tumors that may lead to asymmetric hearing loss, unilateral tinnitus, and vertigo. Population-based data are lacking regarding the incidence of vestibular schwannoma in Asian populations. The aim of this study was to investigate the incidence of vestibular schwannoma in Taiwan using data from a population-based health claim database. SUBJECTS AND METHODS Patients aged 20 years and over with incident cases of vestibular schwannoma between January 1, 2001, and December 31, 2012, were identified from the Longitudinal Health Insurance Database 2000 of the National Health Insurance Research Database (NHIRD), Taiwan, based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 225.1. Only those patients who had received a magnetic resonance imaging scan prior to the diagnosis of vestibular schwannoma were considered as definitive cases. RESULTS 206 cases of vestibular schwannoma were identified during the interval 2001 to 2012. The overall annual incidence was 2.66 per 100 000 persons (95% confidence interval, 2.32-3.05). The annual incidence rate varied throughout the study period, ranging from 1.74 to 3.72 per 100 000 persons. The highest incidence rate of 4.86 per 100 000 persons was observed in the age group of 60 to 69 years. CONCLUSIONS Based on data from the NHIRD in Taiwan for the years 2001 to 2012, the average annual incidence rate of vestibular schwannoma was found to be 2.66 per 100 000 persons.
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Affiliation(s)
- Malcolm Koo
- 1 Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jen-Tsung Lai
- 3 Deparment of Otolaryngology, Kuang-Tien General Hospital, Shalu, Taichung City, Taiwan
| | - Edward Yih-Liang Yang
- 3 Deparment of Otolaryngology, Kuang-Tien General Hospital, Shalu, Taichung City, Taiwan.,4 Department of Speech Language Pathology and Audiology, Hungkuang University, Shalu, Taichung City, Taiwan
| | - Tien-Chen Liu
- 5 Department of Otolaryngology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Juen-Haur Hwang
- 6 Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.,7 School of Medicine, Tzu Chi University, Hualien City, Taiwan
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Caulley L, Sawada M, Hinther K, Ko YTI, Crowther JA, Kontorinis G. Geographic distribution of vestibular schwannomas in West Scotland between 2000-2015. PLoS One 2017; 12:e0175489. [PMID: 28493872 PMCID: PMC5426599 DOI: 10.1371/journal.pone.0175489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background Although the natural history of vestibular schwannomas (VS) has been previously studied, few studies have investigated associated epidemiological factors, primarily because of the lack of large available cohorts. Objective The objective of this study was to perform a multi-scale geographical analysis of the period prevalence of VS in West Scotland from 2000 to 2015. Methods Adults diagnosed with sporadic VS were identified through the National Health Services of West Scotland database and geocoded to the unit postcode. To assess whether the cohort of VS cases could be pooled into a period prevalence measure, the locations of VS cases were analyzed by sex using Cross-L and Difference-K functions. VS period prevalence was examined at two aggregate spatial scales: the postcode district and a coarser scale of NHS Health Boards. The spatial structure of period prevalence within each level of spatial aggregation was measured using univariate global and local Moran’s I. Bivariate local Moran’s I was used to examine the between-scale variability in period prevalence from the postcode district level to the NHS Health Boards levels. Prior to spatial autocorrelation analyses, the period prevalence at the postcode district was tested for stratified spatial heterogeneity within the NHS Health Boards using Wang’s q-Statistic. Results A total of 512 sporadic VS were identified in a population of over 3.1 million. Between 2000 and 2015, VS period prevalence was highest within the NHS Health Boards of Greater Glasgow and Clyde, Ayrshire and Arran and the Western Isles. However, at the NHS scale, period prevalence exhibited no spatial autocorrelation globally or locally. At the district scale, Highland exhibited the most unusual local spatial autocorrelation. Bivariate local Moran’s I results indicated general stability of period prevalence across the postcode district to Health Boards scales. However, locally, some postcode districts in Greater Glasgow and Clyde, Ayrshire and Arran exhibited unusually low district to zone spatial autocorrelation in period prevalence, as did the southern parts of the Western Isles. Some unusually high period prevalence values between the postcode district to Health Board scale were found in Tayside, Forth Valley and Dumfries and Galloway. Conclusion Geographic variability in VS in West Scotland was identified in this patient population, showing that there are areas, even remote, with unusually high or low period prevalence. This can be partially attributed to links between primary and tertiary care. Potential genetic or environmental risk factors that may contribute to geographic variation in this disease within Scotland are also a possibility but require further investigation.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology – Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael Sawada
- Laboratory for Applied Geomatics and GIS Science (LAGGISS), Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelsey Hinther
- Undergraduate Medicine Program, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ya-tung Iris Ko
- Department of Otolaryngology – Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - John A. Crowther
- Department of Otolaryngology – Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Georgios Kontorinis
- Department of Otolaryngology – Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- * E-mail:
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17
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Nilsson J, Holgersson G, Carlsson T, Henriksson R, Bergstrom S, Bergqvist M. Incidence Rates in Low-Grade Primary Brain Tumors: Are There Differences Between Men and Women? A Systematic Review. World J Oncol 2016; 7:59-69. [PMID: 28983366 PMCID: PMC5624701 DOI: 10.14740/wjon976w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Incidence rates of adult low-grade primary brain tumors have previously been widely analyzed nationwide across the world, and most of these studies include data on incidence rates in men and women separately. However, to our knowledge, no worldwide international comparison has been made on possible differences in incidence rates of low-grade brain tumors between men and women. The primary aim was to review the incidence rates between men and women in adult low-grade primary brain tumors. METHODS We searched for published articles in internationally peer reviewed journals that were identified through a systematic search of PubMed. Because of difficulties in interpreting data, we excluded all studies only including patient data before the second edition of World Health Organization (WHO) histological classification system of brain tumors (1993). We also made an overall analysis to calculate incidence rates of low-grade brain tumors in men and women separately. RESULTS A total of 14 studies from the United States and Europe were reviewed. Overall mean age-adjusted incidence rate in men was 1.07 per 100,000 compared to 1.70 per 100,000 in women. No significant difference was seen in age-adjusted incidence rate between genders (Mann-Whitney U test; P = 0.8347). No significant trend of age-adjusted incidence rate was seen in male patients (P = 0.757) nor in women (P = 0.354). CONCLUSION The results must be interpreted with caution and more large international studies are warranted and should be made in a standardized manner differing low-grade tumors from high-grade tumors according to the WHO 2007 brain tumor classification system. Also future studies should always state the ICD-O histology coding to ease future interpretations.
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Affiliation(s)
- Jonas Nilsson
- Center for Research & Development, Uppsala University/County Council of Gavleborg, Gavle Hospital, SE-801 87 Gavle, Sweden
- Department of Radiation Sciences & Oncology, Umea University Hospital, SE-901 87 Umea, Sweden
- Department of Radiology, Gavle Hospiral, SE-801 87 Gavle, Sweden
| | - Georg Holgersson
- Center for Research & Development, Uppsala University/County Council of Gavleborg, Gavle Hospital, SE-801 87 Gavle, Sweden
- Department of Oncology, Gavle Hospital, SE-801 87 Gavle, Sweden
| | - Tobias Carlsson
- Department of Oncology, Gavle Hospital, SE-801 87 Gavle, Sweden
| | - Roger Henriksson
- Department of Radiation Sciences & Oncology, Umea University Hospital, SE-901 87 Umea, Sweden
- Regional Cancer Center Stockholm, Gotland, Sweden
| | - Stefan Bergstrom
- Center for Research & Development, Uppsala University/County Council of Gavleborg, Gavle Hospital, SE-801 87 Gavle, Sweden
- Department of Oncology, Gavle Hospital, SE-801 87 Gavle, Sweden
| | - Michael Bergqvist
- Center for Research & Development, Uppsala University/County Council of Gavleborg, Gavle Hospital, SE-801 87 Gavle, Sweden
- Department of Radiation Sciences & Oncology, Umea University Hospital, SE-901 87 Umea, Sweden
- Department of Oncology, Gavle Hospital, SE-801 87 Gavle, Sweden
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18
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Birth Size Characteristics and Risk of Brain Tumors in Early Adulthood: Results from a Swedish Cohort Study. Cancer Epidemiol Biomarkers Prev 2016; 25:678-85. [DOI: 10.1158/1055-9965.epi-15-1096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/13/2016] [Indexed: 11/16/2022] Open
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Kshettry VR, Hsieh JK, Ostrom QT, Kruchko C, Barnholtz-Sloan JS. Incidence of vestibular schwannomas in the United States. J Neurooncol 2015; 124:223-8. [PMID: 26024654 DOI: 10.1007/s11060-015-1827-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 05/24/2015] [Indexed: 11/24/2022]
Abstract
There is a paucity of population-based data evaluating the incidence of vestibular schwannomas according to age, gender, race, and ethnicity. Such data are necessary to assess the burden of vestibular schwannomas on varying populations and to inform future research and healthcare planning. The Central Brain Tumor Registry of the United States, which contains the largest aggregation of population-based data on the incidence of primary central nervous system tumors in the US, was used. Age-adjusted incidence rates and incidence rate ratios (IRR) of vestibular schwannomas from 2004 to 2010 were calculated by age at diagnosis, gender, race, and ethnicity. Annual percent change (APC) was calculated using Joinpoint to characterize temporal trends. From 2004 to 2010, there were 23,729 newly diagnosed vestibular schwannomas in the US; overall incidence was 1.09 per 100,000 population. Incidence was stable over time (APC -0.41 %, 95 % confidence interval -3.4, 2.7). Incidence increased with age to a peak of 2.93 per 100,000 in the 65-74 year old age group. Overall, there was no difference in incidence by gender. Compared to Whites, incidence was highest in Asian Pacific Islanders (IRR 1.37, p < 0.001) and lowest in African Americans (IRR 0.36, p < 0.001). Incidence was lower in Hispanics than non-Hispanics (IRR 0.69, p < 0.001). Over 3300 vestibular schwannomas are diagnosed per year in the US and incidence is 1.09 per 100,000 population. Incidence increases with age up to the 65-74 year old age group. Incidence is higher in Asian Pacific Islanders and lower in African Americans and Hispanics.
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Affiliation(s)
- Varun R Kshettry
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S40, Cleveland, OH, 44195, USA.
| | - Jason K Hsieh
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave., Wearn 152, Cleveland, OH, 44106-5065, USA
- Central Brain Tumor Registry of the United States, 244 East Ogden Ave, Suite 116, Hinsdale, IL, 60521, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, 244 East Ogden Ave, Suite 116, Hinsdale, IL, 60521, USA
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave., Wearn 152, Cleveland, OH, 44106-5065, USA.
- Central Brain Tumor Registry of the United States, 244 East Ogden Ave, Suite 116, Hinsdale, IL, 60521, USA.
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Fisher JL, Pettersson D, Palmisano S, Schwartzbaum JA, Edwards CG, Mathiesen T, Prochazka M, Bergenheim T, Florentzson R, Harder H, Nyberg G, Siesjö P, Feychting M. Loud noise exposure and acoustic neuroma. Am J Epidemiol 2014; 180:58-67. [PMID: 24786799 DOI: 10.1093/aje/kwu081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The results from studies of loud noise exposure and acoustic neuroma are conflicting. A population-based case-control study of 451 acoustic neuroma patients and 710 age-, sex-, and region-matched controls was conducted in Sweden between 2002 and 2007. Occupational exposure was based on historical measurements of occupational noise (321 job titles summarized by a job exposure matrix) and compared with self-reported occupational noise exposure. We also evaluated self-reported noise exposure during leisure activity. Conditional logistic regression was used to estimate odds ratios. There was no statistically significant association between acoustic neuroma and persistent occupational noise exposure, either with or without hearing protection. Exposure to loud noise from leisure activity without hearing protection was more common among acoustic neuroma cases (odds ratio = 1.47, 95% confidence interval: 1.06, 2.03). Statistically significant odds ratios were found for specific leisure activities including attending concerts/clubs/sporting events (odds ratio = 1.82, 95% confidence interval: 1.09, 3.04) and participating in workouts accompanied by loud music (odds ratio = 2.84, 95% confidence interval: 1.37, 5.89). Our findings do not support an association between occupational exposure to loud noise and acoustic neuroma. Although we report statistically significant associations between leisure-time exposures to loud noise without hearing protection and acoustic neuroma, especially among women, we cannot rule out recall bias as an alternative explanation.
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21
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Innervation of the brain, intracerebral Schwann cells and intracerebral and intraventricular schwannomas. Childs Nerv Syst 2014; 30:815-24. [PMID: 24643709 DOI: 10.1007/s00381-014-2394-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023]
Abstract
The cerebral vasculature and the choroid plexus are innervated by peripheral nerves. The anatomy of the vascular supply to the brain and its related perivascular nerves is reviewed. Intracerebral and intraventricular schwannomas most likely come from neoplastic transformation of Schwann cells investing the perivascular nerves and nerves within the choroid plexus.
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Hardell L, Carlberg M, Söderqvist F, Mild KH. Pooled analysis of case-control studies on acoustic neuroma diagnosed 1997-2003 and 2007-2009 and use of mobile and cordless phones. Int J Oncol 2013; 43:1036-44. [PMID: 23877578 PMCID: PMC3829779 DOI: 10.3892/ijo.2013.2025] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/01/2013] [Indexed: 12/14/2022] Open
Abstract
We previously conducted a case-control study of acoustic neuroma. Subjects of both genders aged 20-80 years, diagnosed during 1997-2003 in parts of Sweden, were included, and the results were published. We have since made a further study for the time period 2007-2009 including both men and women aged 18-75 years selected from throughout the country. These new results for acoustic neuroma have not been published to date. Similar methods were used for both study periods. In each, one population-based control, matched on gender and age (within five years), was identified from the Swedish Population Registry. Exposures were assessed by a self-administered questionnaire supplemented by a phone interview. Since the number of acoustic neuroma cases in the new study was low we now present pooled results from both study periods based on 316 participating cases and 3,530 controls. Unconditional logistic regression analysis was performed, adjusting for age, gender, year of diagnosis and socio-economic index (SEI). Use of mobile phones of the analogue type gave odds ratio (OR) = 2.9, 95% confidence interval (CI) = 2.0-4.3, increasing with >20 years latency (time since first exposure) to OR = 7.7, 95% CI = 2.8-21. Digital 2G mobile phone use gave OR = 1.5, 95% CI = 1.1-2.1, increasing with latency >15 years to an OR = 1.8, 95% CI = 0.8-4.2. The results for cordless phone use were OR = 1.5, 95% CI = 1.1-2.1, and, for latency of >20 years, OR = 6.5, 95% CI = 1.7-26. Digital type wireless phones (2G and 3G mobile phones and cordless phones) gave OR = 1.5, 95% CI = 1.1-2.0 increasing to OR = 8.1, 95% CI = 2.0-32 with latency >20 years. For total wireless phone use, the highest risk was calculated for the longest latency time >20 years: OR = 4.4, 95% CI = 2.2-9.0. Several of the calculations in the long latency category were based on low numbers of exposed cases. Ipsilateral use resulted in a higher risk than contralateral for both mobile and cordless phones. OR increased per 100 h cumulative use and per year of latency for mobile phones and cordless phones, though the increase was not statistically significant for cordless phones. The percentage tumour volume increased per year of latency and per 100 h of cumulative use, statistically significant for analogue phones. This study confirmed previous results demonstrating an association between mobile and cordless phone use and acoustic neuroma.
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Affiliation(s)
- Lennart Hardell
- Department of Oncology, University Hospital, SE-701 85 Örebro, Sweden
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23
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Babu R, Sharma R, Bagley JH, Hatef J, Friedman AH, Adamson C. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. J Neurosurg 2013; 119:121-30. [PMID: 23432451 DOI: 10.3171/2013.1.jns121370] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT There are a variety of treatment options for the management of vestibular schwannomas (VSs), including microsurgical resection, radiotherapy, and observation. Although the choice of treatment is dependent on various patient factors, physician bias has been shown to significantly affect treatment choice for VS. In this study the authors describe the current epidemiology of VS and treatment trends in the US in the modern era. They also illustrate patient and tumor characteristics and elucidate their effect on tumor management. METHODS Patients diagnosed with VS were identified through the Surveillance, Epidemiology, and End Results database, spanning the years 2004-2009. Age-adjusted incidence rates were calculated and adjusted using the 2000 US standard population. The chi-square and Student t-tests were used to evaluate differences between patient and tumor characteristics. Multivariate logistic regression was performed to determine the effects of various patient and tumor characteristics on the choice of tumor treatment. RESULTS A total of 6225 patients with VSs treated between 2004 and 2009 were identified. The overall incidence rate was 1.2 per 100,000 population per year. The median age of patients with VS was 55 years, with the majority of patients being Caucasian (83.16%). Of all patients, 3053 (49.04%) received surgery only, with 1466 (23.55%) receiving radiotherapy alone. Both surgery and radiation were only used in 123 patients (1.98%), with 1504 patients not undergoing any treatment (24.16%). Increasing age correlated with decreased use of surgery (OR 0.95, 95% CI 0.95-0.96; p<0.0001), whereas increasing tumor size was associated with the increased use of surgery (OR 1.04, 95% CI 1.04-1.05; p<0.0001). Older age was associated with an increased likelihood of conservative management (OR 1.04, 95% CI 1.04-1.05; p<0.0001). Racial disparities were also seen, with African American patients being significantly less likely to receive surgical treatment compared with Caucasians (OR 0.50, 95% CI 0.35-0.70; p<0.0001), despite having larger tumors at diagnosis. CONCLUSIONS The incidence of vestibular schwannomas in the US is 1.2 per 100,000 population per year. Although many studies have demonstrated improved outcomes with the use of radiotherapy for small- to medium-sized VSs, surgery is still the most commonly used treatment modality for these tumors. Racial disparities also exist in the treatment of VSs, with African American patients being half as likely to receive surgery and nearly twice as likely to have their VSs managed conservatively despite presenting with larger tumors. Further studies are needed to elucidate the reasons for treatment disparities and investigate the nationwide trend of resection for the treatment of small VSs.
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Affiliation(s)
- Ranjith Babu
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Gamma Knife Treatment of Growing Vestibular Schwannoma in Norway: A Prospective Study. Int J Radiat Oncol Biol Phys 2012; 84:e161-6. [DOI: 10.1016/j.ijrobp.2012.03.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 11/19/2022]
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Palmisano S, Schwartzbaum J, Prochazka M, Pettersson D, Bergenheim T, Florentzson R, Harder H, Mathiesen T, Nyberg G, Siesjö P, Feychting M. Role of tobacco use in the etiology of acoustic neuroma. Am J Epidemiol 2012; 175:1243-51. [PMID: 22517809 PMCID: PMC3372315 DOI: 10.1093/aje/kwr465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Two previous studies suggest that cigarette smoking reduces acoustic neuroma risk; however, an association between use of snuff tobacco and acoustic neuroma has not been investigated previously. The authors conducted a case-control study in Sweden from 2002 to 2007, in which 451 cases and 710 population-based controls completed questionnaires. Cases and controls were matched on gender, region, and age within 5 years. The authors estimated odds ratios using conditional logistic regression analyses, adjusted for education and tobacco use (snuff use in the smoking analysis and smoking in the snuff analysis). The risk of acoustic neuroma was greatly reduced in male current smokers (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.23, 0.74) and moderately reduced in female current smokers (OR = 0.70, 95% CI: 0.40, 1.23). In contrast, current snuff use among males was not associated with risk of acoustic neuroma (OR = 0.94, 95% CI: 0.57, 1.55). The authors' findings are consistent with previous reports of lower acoustic neuroma risk among current cigarette smokers than among never smokers. The absence of an association between snuff use and acoustic neuroma suggests that some constituent of tobacco smoke other than nicotine may confer protection against acoustic neuroma.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Maria Feychting
- Correspondence to Dr. Maria Feychting, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm 171 77, Sweden (e-mail: )
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