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January 31, 2014

Aspirin Slows Brain Tumor Growth (Acoustic Neuroma)

Image from Wikipedia
There is a type of benign brain tumor called acoustic neuroma or vestibular schwannoma that causes progressive hearing loss on just one side. This non-cancerous tumor which arises off the balance/hearing nerve (cranial nerve 8) typically grows larger in size over time leading to not only hearing loss, but also dizziness, facial paralysis, and even death if large enough.

Harvard researchers, however, have recently reported that aspirin may appear to slow and perhaps even halt the growth rate of this benign brain tumor. This is exciting news given that the alternative options include either brain surgery or radiation therapy with all its attendant risks.

Their conclusion was determined by looking at 347 patients diagnosed with this tumor who were followed by serial MRI scans. In this group, 81 took aspirin and 266 did not.  Of those who took aspirin, 33 demonstrated tumor growth whereas 48 did not. Of the 266 non-aspirin users, 154 demonstrated tumor growth and 112 did not. These numbers indicate a significant inverse association among aspirin users and tumor growth which was not confounded by age or sex.

It is hypothesized to work by targeting COX-2 which is a key enzyme in prostaglandin synthesis. This enzyme is also found at high levels in most vestibular schwannomas.

Given aspirin is a relatively benign drug, it certainly can't hurt to start aspirin on all patients who are diagnosed with this condition.

However, there are some key answered questions:

1) What dose of aspirin?
2) Is aspirin effective when started at time of diagnosis, or does it help when a patient has already been on it long-term?

As such, larger study groups in prospective clinical trials would be best to answer these questions as well as confirm whether aspirin truly has a therapeutic role in the management of these tumors.

Reference:
Aspirin Intake Correlates With Halted Growth of Sporadic Vestibular Schwannoma In Vivo. Otology and Neurotology: February 2014 - Volume 35 - Issue 2 - p 353-357 doi: 10.1097/MAO.0000000000000189
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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