The changing face of acoustic neuroma management in the USA: Analysis of the 1998 and 2008 patient surveys from the acoustic neuroma association

Objective. A recent review of the national cancer center registry Surveillance Epidemiology and End Results (SEER) database revealed that in the United States, 25% of Acoustic Neuromas (AN) are managed with observation. Several articles have questioned the aggressive treatment of these slow growing tumors. Concern has been raised that data from the SEER database might be biased towards treatment as patients who chose observation are less likely to be seen at a cancer center. To try and adjust for this potential bias, we decided to investigate management trends of AN in the United States using patient surveys conducted by the Acoustic Neuroma Association (ANA). Study design. Database review. Methods. Data from the 1998 and 2008 ANA patient's surveys were analyzed to detect trends between tumor size and treatment modality. Management trends including observation, microsurgical resection and radiation were examined as well based on tumor size criteria. Results. During this study period, tumor size at diagnosis decreased significantly (1966-1998: 23.8% <= 1.5 cm; 1999-2008: 45.3% <= 1.5 cm). The use of microsurgery decreased from 92.7% to 53.4%, while the use of radiosurgery/radiotherapy increased from 5% to 24.2% and observation increased to 22.4%. Conclusion. Review of data from the ANA confirmed that radiosurgery, and watch and wait are gaining popularity as treatment options. Regardless of this shift in tumor management, microsurgery continues to be the primary method of treatment across tumor sizes in the United States of America and observation remains the least common management modality.