Nonoperative management of acoustic neuroma in geriatric patients: a National Cancer Database analysis

The in-hospital mortality rate of surgery for acoustic neuroma (AN) is 0.5% and increases exponentially with age. There have been no studies examining the nationwide distribution of nonoperative management (radiation or observation) in the geriatric (≥ age 65) AN population. The National Cancer Database (NCDB) from 2004 to 2013 identified geriatric AN patients. Multivariable logistic regression adjusted for patient age, race, sex, income, geographic region, primary payer for care, tumor size, and comorbidities. Of the 11,614 AN patients, 1725 (14.9%) were geriatric; median tumor size was 2.1 cm. Solitary treatment was administered as radiation (13%), observation (8.5%), and surgery (74.5%). Men (OR = 1.3, p = 0.03) and comprehensive cancer center (CCC) treatment (OR = 1.4, p = 0.02) were more likely to receive radiation. African-American race (OR = 1.5, p = 0.03) was associated with increased observation, while comorbidities (OR = 0.7, p = 0.03) were associated with decreased observation. Fifteen percent of the AN population is ≥ age 65, with surgery the most commonly used treatment modality. Male gender and CCC treatment independently predict receipt of radiation, while African-American race independently predicts receipt of observation. Given the proven impact of radiation on local control in AN, there is fertile ground for dissemination of radiation treatment for geriatric AN patients.