Current Evidence on Medical Therapy for Sporadic Vestibular Schwannoma: A Systematic Review and Meta-analysis
Abstract
Objective: To systematically review studies evaluating systemic medical therapies for sporadic vestibular schwannoma (VS) and perform meta-analyses to assess associations with tumor control.
Study design: Systematic review and meta-analysis.
Setting: Not applicable.
Patients: Sporadic VS patients.
Interventions: Systemic medical therapies.
Main outcome measures: Tumor growth.
Results: Nine retrospective studies met criteria: 5 on nonsteroidal anti-inflammatory drugs (NSAIDs), 3 on metformin, and 1 on losartan (all level 3 evidence). A meta-analysis of ORs from 5 studies demonstrated no significant association between aspirin use and tumor growth (pooled OR: 0.77; 95% CI: 0.48-1.23; I²: 76%). Conversely, a meta-analysis of ORs from 3 studies on metformin showed significantly lower odds of tumor growth (pooled OR: 0.46; 95% CI: 0.30-0.72; I²: 0%). The study on losartan did not identify a statistically significant association of losartan with tumor growth. Less than half of the studies reported HRs to appropriately reflect the inherently time-dependent nature of tumor growth.
Conclusions: Evidence for systemic therapies in sporadic VS remains preliminary. Our meta-analysis of ORs demonstrates that NSAID use is not significantly associated with tumor growth, metformin users had lower odds of tumor growth, and evidence for losartan remains limited; however, all available studies provide only level 3 evidence. At present, there is insufficient data to recommend routine use of…
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