Is there a way to medically stop the progression of sporadic vestibular schwannoma growth?
Background: Sporadic vestibular schwannomas (sVS) have a variable and often unpredictable growth pattern. In addition, there is an unpredictable relationship between the size of the tumor and the level of hearing. All clinicians have seen small tumors in patients with total hearing loss and large tumors in patients with good hearing.
Explore this issue:March 2014
Study design: Retrospective case review.
Setting: Massachusetts Eye and Ear Infirmary, Boston.
Synopsis: Current patient management of sVS includes conservative management with serial MRI if the tumor is stable and potential morbidities are stable. If growth is demonstrated, the treatment options are stereotactic radiation or surgical removal. Of note is the fact that various solid tumors (various breast and colon cancers) are known to be modulated by anti-inflammatory medication, including aspirin. The authors and others have previously demonstrated several molecular targets and inflammatory pathways involved in sVS pathogenesis. These identified pathways include cyclooxygenase 2 (COX-2) and nuclear factor kappa B (NF-κB), a major transcription factor. Aspirin and other anti-inflammatory medications inhibit NF-κB, which in turn decreases COX-2 production.
In this study, the authors performed a retrospective review of 347 sVS patients, of which 81 (23%) were aspirin users and 266 (77%) were not. Of the 81 aspirin users, 48 (59%) had no growth; of the 266 non-aspirin users, 112 (41%) had no growth. Their statistical analysis verified that this difference is significant.
Bottom line: This retrospective study is an encouraging step in identifying potential medications (anti-inflammatory agents) to use in slowing vestibular schwannoma growth.
Citation: Kandathil CK, Dilwali S, Wu CC, et al. Aspirin intake correlates with halted growth of sporadic vestibular schwannoma in vivo. Otol Neurotol. 2014;35:353-357.