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Vaishnav YJ, Singh R, Didwania P, Lehrer EJ, Bakaeva T, Harris TJ, Migliori ME, Sheehan JP, Trifiletti DM. Radiotherapy and Radiosurgery in the Management of Optic Nerve Sheath Meningiomas: An International Systematic Review and Meta-Analysis of Twenty Studies. World Neurosurg 2022; 164:e929-e944. [PMID: 35609728 DOI: 10.1016/j.wneu.2022.05.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Optic nerve sheath meningiomas (ONMs) are often managed with radiotherapy (RT) with the goal of achieving radiographic local control (LC) and preventing deterioration of visual acuity (VA). We aimed to perform a systematic review and meta-analysis of outcomes for patients with ONM treated with RT. METHODS The PICOS/PRISMA/MOOSE selection criteria were used to identify studies. Primary outcomes were stable or improved VA and radiographic LC at last follow-up. The secondary outcomes were incidences of radiation-induced retinopathy and xerophthalmia and stable or improved visual fields (VFs). Weighted random-effects meta-analyses using the DerSimonian and Laird methods were conducted to characterize effect sizes. Mixed-effects regression models were used to examine potential correlations between gross tumor volume (GTV) and outcomes. RESULTS In total, 444 patients with ONM across 20 published studies were included. The estimated LC rate was 99.8% (95% confidence interval [CI], 98.3%-100%), and the estimated proportion of patients with stable or improved VA or VF was 89.7% (95% CI, 86.2%-92.4%) and 93.3% (95% CI, 89.5%-95.8%), respectively. Estimated incidences of radiation-induced retinopathy and xerophthalmia were 7.2% and 10.1%, respectively. GTV was significantly associated with VA (P = 0.014) with estimated VA rates of 96.4%, 91.4%, and 80.5% for GTVs of 2.0, 3.0, and 4.0 cm3, respectively. CONCLUSIONS RT was well tolerated, with excellent LC achieved. Nearly 90% of patients noted either stability or improvement in VA and VF. Larger ONMs were associated with poorer VA.
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Affiliation(s)
- Yash J Vaishnav
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Prabhanjan Didwania
- Rady School of Management, University of California San Diego, San Diego, California, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tatiana Bakaeva
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Timothy J Harris
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Michael E Migliori
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
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Bevacizumab for Radiation Induced Optic Neuritis Among Aggressive Residual/Recurrent Suprasellar Tumors: More Than a Mere Antineoplastic Effect. World Neurosurg 2017; 107:1044.e5-1044.e10. [DOI: 10.1016/j.wneu.2017.07.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/21/2022]
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Mizumoto M, Yamamoto T, Takano S, Ishikawa E, Matsumura A, Ishikawa H, Okumura T, Sakurai H, Miyatake SI, Tsuboi K. Long-term survival after treatment of glioblastoma multiforme with hyperfractionated concomitant boost proton beam therapy. Pract Radiat Oncol 2015; 5:e9-16. [DOI: 10.1016/j.prro.2014.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 01/21/2023]
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Proton beam therapy for malignancy in Bloom syndrome. Strahlenther Onkol 2013; 189:335-8. [DOI: 10.1007/s00066-012-0274-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/08/2012] [Indexed: 12/21/2022]
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Kosaki K, Ecker S, Habermehl D, Rieken S, Jäkel O, Herfarth K, Debus J, Combs SE. Comparison of intensity modulated radiotherapy (IMRT) with intensity modulated particle therapy (IMPT) using fixed beams or an ion gantry for the treatment of patients with skull base meningiomas. Radiat Oncol 2012; 7:44. [PMID: 22439607 PMCID: PMC3338385 DOI: 10.1186/1748-717x-7-44] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 03/22/2012] [Indexed: 12/25/2022] Open
Abstract
Background To examine the potential improvement in treatment planning for patients with skull base meningioma using IMRT compared to carbon ion or proton beams with and without a gantry. Methods Five patients originally treated with photon IMRT were selected for the study. Ion beams were chosen using a horizontal beam or an ion gantry. Intensity controlled raster scanning and the intensity modulated particle therapy mode were used for plan optimization. The evaluation included analysis of dose-volume histograms of the target volumes and organs at risk. Results In comparison with carbon and proton beams only with horizontal beams, carbon ion treatment plans could spare the OARs more and concentrated on the target volumes more than proton and photon IMRT treatment plans. Using only a horizontal fixed beam, satisfactory plans could be achieved for skull base tumors. Conclusion The results of the case studies showed that using IMPT has the potential to overcome the lack of a gantry for skull base tumors. Carbon ion plans offered slightly better dose distributions than proton plans, but the differences were not clinically significant with established dose prescription concepts.
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Affiliation(s)
- Katsura Kosaki
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
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Fukumitsu N, Oshiro Y, Hashimoto T, Okumura T, Mizumoto M, Moritake T, Tsuboi K, Sakae T, Sakurai H. Verification of beam delivery using fibrosis after proton beam irradiation to the lung tumor. Lung Cancer 2012; 77:83-8. [PMID: 22281073 DOI: 10.1016/j.lungcan.2012.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 12/02/2011] [Accepted: 01/09/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the geometrical accuracy in proton beam therapy (PBT) to the lung by comparing the location of the fibrosis after PBT and the tumor using less invasive method. PATIENTS AND METHODS We examined 50 lung tumors that had been treated by respiratory-gated PBT (33-74 Gray equivalents). Image registration and re-slicing of computed tomography (CT) before and after PBT were performed using an image analysis software system. We investigated whether the location of fibrosis was accurate with the tumor site and which factor among the respiratory rhythm, tumor volume, location, fixation, beam direction and clinical outcome was affected with accuracy. RESULTS The area of fibrosis was accurate with the tumor in 45 tumors (Group A) and not accurate in 5 tumors (Group B). All lesions with a small irregularity of respiratory rhythm showed fibrosis in an area accurate with the tumor. This percentage (100%) was higher than that of the lesions with a large irregularity of respiratory rhythm (67%, p = 0.037). Radiation pneumonitis was found for 1 lesion in group A and 2 lesions in Group B (p = 0.0009). CONCLUSION The geometrical accuracy of beam delivery to the lung was higher in the patients with a regular respiratory rhythm in PBT. The patients of Group B had greater risk of pneumonitis.
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Fukumitsu N, Okumura T, Mizumoto M, Oshiro Y, Hashimoto T, Kanemoto A, Hashii H, Ohkawa A, Moritake T, Tsuboi K, Tabuchi K, Wada T, Hara A, Sakurai H. Outcome of T4 (International Union Against Cancer Staging System, 7th edition) or recurrent nasal cavity and paranasal sinus carcinoma treated with proton beam. Int J Radiat Oncol Biol Phys 2011; 83:704-11. [PMID: 22099036 DOI: 10.1016/j.ijrobp.2011.07.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/21/2011] [Accepted: 07/14/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the clinical features, prognostic factors, and toxicity of treatment for unresectable carcinomas of the nasal cavity and paranasal sinus (NCPS) treated with proton beam therapy (PBT). METHODS AND MATERIALS Seventeen patients (13 men, 4 women) with unresectable carcinomas of the NCPS who underwent PBT at the University of Tsukuba between 2001 and 2007 were analyzed. The patients' median age was 62 years (range, 30-83 years). The tumors were located in the nasal cavity in 3 patients, the frontal sinus in 1, the ethmoid sinus in 9, and the maxillary sinus in 4. The clinical stage was Stage IVA in 5 cases, IVB in 10, and recurrent in 2. The tumors were deemed unresectable for medical reasons in 16 patients and because of refusal at a previous hospital 4 months earlier in 1 patient. All the patients received PBT irradiation dose of 22-82.5 GyE and a total of 72.4-89.6 GyE over 30-64 fractions (median 78 GyE over 36 fractions) with X-ray, with attention not exceeding the delivery of 50 GyE to the optic chiasm and brainstem. RESULTS The overall survival rate was 47.1% at 2 years and 15.7% at 5 years, and the local control rate was 35.0% at 2 years and 17.5% at 5 years. Invasion of the frontal or sphenoid sinus was a prognostic factor for overall survival or local control. Late toxicity of more than Grade 3 was found in 2 patients (brain necrosis in 1 and ipsilateral blindness in 1); however, no mortal adverse effects were observed. CONCLUSION Proton beam therapy enabled a reduced irradiation dose to the optic chiasm and brainstem, enabling the safe treatment of unresectable carcinomas in the NCPS. Superior or posterior extension of the tumor influenced patient outcome.
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Brualla L, Palanco-Zamora R, Steuhl KP, Bornfeld N, Sauerwein W. Monte Carlo Simulations Applied to Conjunctival Lymphoma Radiotherapy Treatment. Strahlenther Onkol 2011; 187:492-8. [DOI: 10.1007/s00066-011-2237-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 04/08/2011] [Indexed: 11/28/2022]
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Jensen JM, Gau T, Schultze J, Lemmnitz G, Fölster-Holst R, May T, Abels C, Proksch E. Treatment of acute radiodermatitis with an oil-in-water emulsion following radiation therapy for breast cancer: a controlled, randomized trial. Strahlenther Onkol 2011; 187:378-84. [PMID: 21603988 DOI: 10.1007/s00066-011-2224-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/23/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND A side effect of radiotherapy for breast cancer is acute radiodermatitis. It is a common practice to keep irradiated skin dry on account of data from the 1950s that suggested this regimen limits dermatitis. However, severe dryness of the skin induced by irradiation results in itching and discomfort. Dry skin is characterized by scaliness, epidermal barrier dysfunction, and reduced stratum corneum hydration, and these signs and symptoms are reduced by treatment with an emulsion. PATIENTS AND METHODS We performed a randomized, controlled, open-label study with 66 patients (ITT population), treating the irradiated skin in one group (n = 34) with an oil-in-water emulsion (WO1932), while leaving the other group untreated (n = 32). Clinical scoring (ONS radiation skin reaction scoring, pruritus) and biophysical measurements (stratum corneum hydration and transepidermal water loss (TEWL), as a marker of skin barrier function) were determined at day 1 (directly after termination of the radiation therapy), day 8, and day 47 (± 7). RESULTS Irradiation increased the ONS score and pruritus, whereas skin hydration and TEWL were reduced. The primary hypothesis that the increase in skin hydration was significantly greater in the emulsion-treated compared to the untreated group as early as after 8 days of treatment could not be confirmed. At the end of the study (day 47 ± 7), however, normalization of stratum corneum hydration was more advanced in the treatment group compared to the untreated group and nearly reached the values of the contralateral healthy breast skin. ONS score and pruritus also revealed an advantage for the emulsion-treated group. TEWL did not show significant changes during emulsion treatment. No adverse events were caused by the treatment regimens CONCLUSION Treatment of radiodermatitis with an oil-in-water emulsion was well tolerated, enhanced stratum corneum hydration, improved clinical indicators, and provided relief from itching.
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Affiliation(s)
- Jens-Michael Jensen
- Department of Dermatology, University Hospitals of Schleswig-Holstein, University of Kiel, Germany.
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Matuschek C, Bölke E, Nawatny J, Hoffmann TK, Peiper M, Orth K, Gerber PA, Rusnak E, Lammering G, Budach W. Bevacizumab as a treatment option for radiation-induced cerebral necrosis. Strahlenther Onkol 2011; 187:135-9. [PMID: 21336713 DOI: 10.1007/s00066-010-2184-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 11/11/2010] [Indexed: 12/14/2022]
Abstract
Radiation necrosis of normal CNS tissue represents one of the main risk factors of brain irradiation, occurring more frequently and earlier at higher total doses and higher doses per fraction. At present, it is believed that the necrosis results due to increasing capillary permeability caused by cytokine release leading to extracellular edema. This process is sustained by endothelial dysfunction, tissue hypoxia, and subsequent necrosis. Consequently, blocking the vascular endothelial growth factor (VEGF) at an early stage could be an option to reduce the development of radiation necrosis by decreasing the vascular permeability. This might help to reverse the pathological mechanisms, improve the symptoms and prevent further progression. A patient with radiationinduced necrosis was treated with an anti-VEGF antibody (bevacizumab), in whom neurologic signs and symptoms improved in accordance with a decrease in T1-weighted fluid-attenuated inversion recovery signals. Our case report together with the current literature suggests bevacizumab as a treatment option for patients with symptoms and radiological signs of cerebral necrosis induced by radiotherapy.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
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