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Shuto T, Matsunaga S, Sasame J. Stereotactic intensity-modulated radiotherapy for skull base meningioma using the HybridArc with Novalis STx system. Surg Neurol Int 2023; 14:420. [PMID: 38213458 PMCID: PMC10783683 DOI: 10.25259/sni_815_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024] Open
Abstract
Background Skull base meningiomas are often difficult to remove completely with preserved nerve function and may require radiation therapy. However, the Gamma Knife is unsuitable for large tumor volume or the optic nerve, which is difficult to identify on imaging. We report the results of stereotactic radiotherapy with HybridArc using Novalis STx for skull base meningiomas. Methods We retrospectively examined 28 patients with skull base meningioma who underwent stereotactic radiotherapy (54 Gy/30 fractions) with HybridArc. Results The 28 patients, nine males and 19 females, were aged 31-83 years (mean 58.4 years), and the tumor volume was 2.6-97.1 mL (mean 29.7 mL). HybridArc irradiation was performed with D95 54 Gy/30 fractions for all patients with a median follow-up period of 36.0 months (range: 12-78 months). Tumor control rates at 1, 2, and 5 years after radiotherapy were 92.6%, 89.1%, and 82.8%, respectively. Only one non-atypical meningioma remained uncontrolled; thus, the tumor control rate for non-atypical meningioma at 1, 2, and 5 years was 94.1%. Tumor control rates for atypical meningioma at 1, 2, and 5 years were 85.7%, 71.4%, and 53.6%, respectively, significantly worse than for non-atypical meningiomas (P = 0.0395). Radiation injury was observed in two cases (7.1%). Visual field defects were observed in 16 patients, and diplopia in 6. Visual field and diplopia improvements were achieved in 5 and 2 patients, respectively (with overlap). Conclusion Stereotactic radiotherapy (54 Gy/30 fractions) with HybridArc using Novalis STx is a safe and effective approach for relatively large skull base meningiomas.
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Affiliation(s)
- Takashi Shuto
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan
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Takase H, Yamamoto T. Bone Invasive Meningioma: Recent Advances and Therapeutic Perspectives. Front Oncol 2022; 12:895374. [PMID: 35847854 PMCID: PMC9280135 DOI: 10.3389/fonc.2022.895374] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Meningioma is the most common primary neoplasm of the central nervous system (CNS). Generally, these tumors are benign and have a good prognosis. However, treatment can be challenging in cases with aggressive variants and poor prognoses. Among various prognostic factors that have been clinically investigated, bone invasion remains controversial owing to a limited number of assessments. Recent study reported that bone invasion was not associated with WHO grades, progression, or recurrence. Whereas, patients with longer-recurrence tended to have a higher incidence of bone invasion. Furthermore, bone invasion may be a primary preoperative predictor of the extent of surgical resection. Increasing such evidence highlights the potential of translational studies to understand bone invasion as a prognostic factor of meningiomas. Therefore, this mini-review summarizes recent advances in pathophysiology and diagnostic modalities and discusses future research directions and therapeutic strategies for meningiomas with bone invasion.
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Affiliation(s)
- Hajime Takase
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- *Correspondence: Hajime Takase, ; orcid.org/0000-0001-5813-1386
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Mazloomi F, Abedi I, Shanei A, Dalvand F, Amouheidari A. Investigating the number of radiation fields in intensity-modulated radiotherapy plans of optic nerve sheath meningioma patients using dose gradient index. Biomed Phys Eng Express 2022; 8. [PMID: 35321959 DOI: 10.1088/2057-1976/ac6059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/23/2022] [Indexed: 11/11/2022]
Abstract
Purpose:In optic nerve radiotherapy, vital organs are very close to the target volume, they are highly sensitive to radiation and have low dose tolerance. In this regard, evaluating dose fall-off steepness around the target volume is required to assess various intensity-modulated radiation therapy (IMRT) plans in the treatment of the optic nerve sheath meningioma (ONSM) patients.Materials and Methods:Thirteen ONSM patients were analyzed with three IMRT techniques, including three (IMRT-3F), five (IMRT-5F), and seven fields (IMRT-7F). These plans were studied using Dmean, Dmax, D2%, D98%, V100%, uniformity index (UI), homogeneity index (HI), conformity index (CI), and specifically the dose gradient indices (DGIs). Results: The values of Dmaxand Dmeanfor IMRT-3F, IMRT-5F and IMRT-7F were (5637.42 ± 57.08, 5322.84 ± 83.86), (5670.51 ± 67.87, 5383.00 ± 58.45), and (5692.99 ± 31.65, 5405.72 ± 51.73), respectively, which were increased with increment in the number of IMRT fields from 3 to 7. The UI and HI indices were significantly different between IMRT-3F and IMRT-7F (p=0.010 and p=0.005, respectively), and CI was close to the ideal value (0.99±0.01) in IMRT-7F. The significant findings of the dose gradient indices represented smaller values in IMRT-7F, which led to a faster dose fall-off, particularly at the 70%-85% isodose levels around the target. Conclusion: Increasing the number of radiation fields in IMRT treatment plans of ONSM patients had a considerable difference in both the dosimetric parameters of the target volume and at-risk organs, as well as the dose gradient indices. Overall, IMRT-7F could be considered as a preferred technique in the treatment of this meningioma.
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Affiliation(s)
- Fahimeh Mazloomi
- Department of Medical Physics, Isfahan University of Medical Sciences and Health Services Faculty of Medicine, Hezar Jarib St., Isfahan, Isfahan, 9413645489, Iran (the Islamic Republic of)
| | - Iraj Abedi
- Department of Medical Physics, Isfahan University of Medical Sciences and Health Services Faculty of Medicine, Hezar Jarib St., Isfahan, Isfahan, 9413645489, Iran (the Islamic Republic of)
| | - Ahmad Shanei
- Department of Medical Physics, Isfahan University of Medical Sciences and Health Services Faculty of Medicine, Hezar Jarib St., Isfahan, Isfahan, 9413645489, Iran (the Islamic Republic of)
| | - Fatemeh Dalvand
- Nuclear Engineering, Shahid Beheshti University, Daneshjou Blvd, Tehran, Tehran, 1983969411, Iran (the Islamic Republic of)
| | - Alireza Amouheidari
- Radiation Oncology Department, Isfahan Milad Hospital, Shahrak-e Valieasr (Keshavarz Blvd), Isfahan, Isfahan, 8179663467, Iran (the Islamic Republic of)
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Yang J, Kudulaiti N, Chen Z, Gao L, Hameed NUF, Feng R, Lu S. OUP accepted manuscript. Cereb Cortex 2022; 32:4422-4435. [PMID: 35106532 DOI: 10.1093/cercor/bhab492] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jingwen Yang
- Teaching Laboratory of Neurolinguistics, Department of Chinese Language and Literature, Sun Yat-sen University, Guangzhou 510275, P.R. China
- Department of Clinical Neurolinguistic Research, Mental and Neurological Diseases Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, P.R. China
| | - Nijiati Kudulaiti
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- Neurosurgical Institute of Fudan University, Shanghai 200040, P.R. China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, P.R. China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, P.R. China
| | - Zelin Chen
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - Leyan Gao
- Teaching Laboratory of Neurolinguistics, Department of Chinese Language and Literature, Sun Yat-sen University, Guangzhou 510275, P.R. China
| | - N U Farrukh Hameed
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- Neurosurgical Institute of Fudan University, Shanghai 200040, P.R. China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, P.R. China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, P.R. China
| | - Rui Feng
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- Neurosurgical Institute of Fudan University, Shanghai 200040, P.R. China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, P.R. China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, P.R. China
| | - Shuo Lu
- Department of Clinical Neurolinguistic Research, Mental and Neurological Diseases Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, P.R. China
- School of Foreign langugues, Shenzhen University, Shenzhen, 518060, P.R. China
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Sato H, Mizumoto M, Okumura T, Sakurai H, Sakamoto N, Akutsu H, Ishikawa E, Tsuboi K. Long-term outcomes of patients with unresectable benign meningioma treated with proton beam therapy. JOURNAL OF RADIATION RESEARCH 2021; 62:427-437. [PMID: 33855438 PMCID: PMC8127652 DOI: 10.1093/jrr/rrab017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Indexed: 05/07/2023]
Abstract
This study aimed to evaluate the long-term efficacy of proton beam therapy (PBT) for unresectable benign meningiomas at the University of Tsukuba, Japan. From 1986-1998, 10 patients were treated at the Particle Radiation Medical Science Center (PRMSC) with a relative biological effectiveness (RBE) value of 1.0 using an accelerator built for physics experiments. The total dose was compensated with an X-ray in three patients. Following that, from 2002-2017, 17 patients were treated with a RBE value of 1.1 at the Proton Medical Research Center (PMRC) which was built for medical use. At the PRMSC, the total dose ranged from 50.4-66 Gy (median: 54 Gy). During the follow-up, which lasted between 3.8 and 31.6 years (median: 25.1 years), the 5-, 10-, 15-, 20- and 30-year local control rates were 100%, and the 5-, 10-, 15-, 20- and 30-year survival rates were 90, 80, 70, 70 and 36%, respectively. One patient died of brainstem radiation necrosis 5.1 years after PBT. At PMRC, the total dose ranged from 45.0-61.2 GyE, with a median of 50.4 GyE. During the follow-up, which lasted between 3 and 17 years with a median of 10.5 years, the 5-, 10- and 15-year local control rates were 94.1%, and the 5-, 10- and 15-year survival rates were 100, 100 and 88.9%, respectively. Neither malignant transformation nor secondary malignancy was observed, indicating that fractionated PBT may be effective and safely control benign unresectable meningioma even for the lifelong period of time.
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Affiliation(s)
- Hiroshige Sato
- Biomedical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Beam Therapy Center, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Beam Therapy Center, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Beam Therapy Center, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Noriaki Sakamoto
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Koji Tsuboi
- Tumor Therapy Center, Tsukuba Central Hospital, 1589-3 Kashiwada, Ushiku, Ibaraki 300-1211, Japan
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Abstract
Objective This study was aimed to review issues relating to the recognition, radiographic diagnosis, monitoring, and management of primary and secondary optic nerve sheath meningioma (ONSM). Design This study is a review of peer-reviewed literature combined with illustrative case studies. Participants and Methods A literature search was conducted via the PubMed database using pertinent search terms. Selected articles were limited to those written or translated into English. Additional works cited within articles were also included. Individual cases were drawn from the experience of a tertiary academic neuroophthalmic and orbital practice. Tables summarize radiotherapeutic and surgical studies, excluding single case reports and studies focusing on meningioma of intracranial origin. Main Outcome Measurements Review of reported surgical and radiotherapeutic series is the primary measurement. Results The natural history of optic nerve sheath meningiomas is primarily characterized by progressive ipsilateral vision loss. Diagnosis is typically based on radiographic imaging findings, with biopsy remaining indicated in some patients. Management strategies may include observation, radiation, and/or surgical intervention, or a combination of these approaches. The role of surgery, especially with respect to primary ONSM (pONSM), remains controversial. Advancement of radiotherapy techniques has shifted modern treatment paradigms in pONSM toward radiation as primary treatment, as surgical outcomes are inferior in major studies. Although radiation remains the treatment of choice in many cases, selected patients may benefit from surgery, especially in the setting of secondary ONSM (sONSM). Conclusion A wide variety of radiotherapeutic and surgical treatment modalities for ONSM exist. The specific indications for each management strategy continue to be redefined.
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Affiliation(s)
- Elena Solli
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Divisions of Neuro-ophthalmology and Oculoplastics/Orbital Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Roger E. Turbin
- Divisions of Neuro-ophthalmology and Oculoplastics/Orbital Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States
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Optimal management in optic nerve sheath meningioma – A multicentre study and pooled data analysis. J Clin Neurosci 2020; 80:162-168. [DOI: 10.1016/j.jocn.2020.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/27/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
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Sasano H, Shikishima K, Aoki M, Sakai T, Tsutsumi Y, Nakano T. Efficacy of intensity-modulated radiation therapy for optic nerve sheath meningioma. Graefes Arch Clin Exp Ophthalmol 2019; 257:2297-2306. [PMID: 31377848 DOI: 10.1007/s00417-019-04424-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The present study examined the efficacy and complications associated with intensity-modulated radiation therapy (IMRT) for optic nerve sheath meningioma (ONSM) in 15 cases and compared visual function before and after treatment. METHODS Consecutively diagnosed patients with ONSM treated with IMRT were evaluated from 2012 to 2017. We categorized ONSM with three growth patterns (diffuse, fusiform, or globular). Visual acuity, visual fields, and optic disc findings were assessed before and after IMRT. Ocular and systemic complications were evaluated during and after treatment. RESULTS The 15 patients selected for analysis ranged in age from 33 to 77 years. Post-treatment observation periods were 8 to 57 months. After IMRT, tumor enlargement was not detected in any eyes, and tumor reduction was seen in 2 eyes. At final post-treatment follow-up, eyes with fusiform and globular growth maintained better visual acuity compared with pre-treatment, whereas 2 of 5 eyes with diffuse growth showed reduced vision. Five eyes with no apparent optic disc abnormality maintained better visual acuity compared with pre-treatment, whereas 8 of 10 eyes with disc edema and atrophy remained stable or showed reduced vision. Improvements were seen in all 5 eyes with optic discs negative for pre-treatment abnormalities. Final post-treatment visual field abnormalities improved in 11 eyes. All adverse events identified during IMRT improved rapidly during the treatment period. CONCLUSION IMRT for the treatment of ONSM achieved improvement and preserved visual function. In particular, early treatment with IMRT before the appearance of optic disc abnormalities can be more effective for improving visual function.
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Affiliation(s)
- Hiroyuki Sasano
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Keigo Shikishima
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsutomu Sakai
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuki Tsutsumi
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Parker RT, Ovens CA, Fraser CL, Samarawickrama C. Optic nerve sheath meningiomas: prevalence, impact, and management strategies. Eye Brain 2018; 10:85-99. [PMID: 30498385 PMCID: PMC6207092 DOI: 10.2147/eb.s144345] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate is practically zero, these tumors can blind or disfigure patients. Given that the clinical course can be variable, and treatment has the capacity to cause morbidity itself, the management of these patients can be difficult. We review the literature to discuss the prevalence of optic nerve sheath meningiomas, the association with neurofibromatosis type 2, natural history, and management options and strategies.
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Affiliation(s)
- Richard T Parker
- Sydney Medical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia,
| | - Christopher A Ovens
- Sydney Medical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia,
| | - Clare L Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Chameen Samarawickrama
- Sydney Medical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia, .,Department of Ophthalmology, Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia,
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Inoue T, Mimura O, Masai N, Ohashi A, Ikenaga K, Okuno Y, Nishiguchi I, Oh R. Early intervention using high-precision radiotherapy preserved visual function for five consecutive patients with optic nerve sheath meningioma. Int J Clin Oncol 2018; 23:826-834. [PMID: 29713911 PMCID: PMC6154112 DOI: 10.1007/s10147-018-1284-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND There has been a paradigm shift in the treatment for optic nerve sheath meningioma (ONSM) from surgery to fractionated stereotactic radiotherapy (FSRT) in other countries. However, FSRT has seldom been performed in Japan. The purpose of this retrospective study is to reconfirm the effectiveness of early intervention with precision radiotherapy for ONSM reported in our previous study. METHODS Five consecutive patients with ONSM were retrospectively analyzed. All patients underwent intensity-modulated radiotherapy (IMRT) or FSRT. They received the early interventions between 1.5 and 7 months after deterioration of the disease. The median dose was 52.8 Gy (range 46.0-59.4 Gy) and the median number of fractions was 25 (range 22-33). RESULTS All patients experienced reestablishment of vision at the median follow-up time of 36 months (range 18-54 months). Four of them noted early improvement of visual deficits during the treatment course (range 2-4 weeks) and the remaining patient improved 3 weeks after completion of IMRT. The median tumor reduction was 53% (range 39-75%). One patient with diabetes mellitus developed retinal bleeding as a result of radiation retinopathy 16 months after IMRT, although the doses were acceptable. The remaining 4 patients have no late toxicity at the follow-up time of 31-54 months. CONCLUSIONS A paradigm shift is necessary from surgery to early intervention using precision radiotherapy for the treatment of ONSM in Japan.
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Affiliation(s)
- Toshihiko Inoue
- Ashiya Radiotherapy Clinic Nozomi, 3-84 Yoko-cho, Ashiya, 659-0034, Japan.
| | - Osamu Mimura
- Department of Neuro-ophthalmological Therapeutics, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Atuyuki Ohashi
- Ashiya Radiotherapy Clinic Nozomi, 3-84 Yoko-cho, Ashiya, 659-0034, Japan
| | - Koji Ikenaga
- Ashiya Radiotherapy Clinic Nozomi, 3-84 Yoko-cho, Ashiya, 659-0034, Japan
| | - Yoshishige Okuno
- Ashiya Radiotherapy Clinic Nozomi, 3-84 Yoko-cho, Ashiya, 659-0034, Japan
| | - Iku Nishiguchi
- Ashiya Radiotherapy Clinic Nozomi, 3-84 Yoko-cho, Ashiya, 659-0034, Japan
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Charpentier P, Mouriaux F. Total recovery of optic nerve sheath meningioma. BMJ Case Rep 2016; 2016:bcr-2016-215532. [PMID: 27769976 DOI: 10.1136/bcr-2016-215532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We reported the case of a 43-year-old woman with a rapid progressive visual loss. The diagnosis of primary optic nerve sheath meningioma was made thanks to atypia evolution, clinical and radiological findings. The patient was treated with an intensity-modulated radiotherapy of 50.4 Gy in 28 fractions 2 months after the diagnosis. Visual acuity and visual field were completely recovered after 2 years of follow-up. No late side effects of irradiation were recorded.
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Affiliation(s)
- Pierre Charpentier
- Centre Hospitalier Universitaire de Rennes, ille et Vilaine, Rennes, Catalunya, Girona, Spain
| | - Frederic Mouriaux
- Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
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Mao JF, Xia XB, Tang XB, Zhang XY, Wen D. Analyses on the misdiagnoses of 25 patients with unilateral optic nerve sheath meningioma. Int J Ophthalmol 2016; 9:1315-9. [PMID: 27672598 DOI: 10.18240/ijo.2016.09.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/09/2015] [Indexed: 12/16/2022] Open
Abstract
AIM To investigate clinical features of optic nerve sheath meningioma (ONSM) that was misdiagnosed, and to find methods to reduce the misdiagnoses. METHODS Retrospective series study. Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan. 2008 to Jan. 2015 and the clinical records reviewed. RESULTS Patients were misdiagnosed with acute papillitis most frequently (n=17), immediately followed by optic atrophy (n=8), ischemic optic neuropathy (n=5), acute retrobulbar optic neuritis (n=5), optic disc vasculitis (n=3). For each patient, the minimum frequency of misdiagnoses was once and the maximum was 4 times. As for the lasting time of being misdiagnosed, the shortest was 1.5mo and the longest was 45mo. Twenty-one cases (84%) were once treated with glucocorticoids, and its side effects was found in seventeen patients. Twenty patients (80%) complained with varying degree of vision loss. When a definite diagnosis was made, sixteen cases (64%) showed slight exophthalmos and eighteen cases (72%) had the tubular ONSM. CONCLUSION ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic, and for most of these ONSMs are tubular.
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Affiliation(s)
- Jun-Feng Mao
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Xiao-Bo Xia
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Xiang-Bo Tang
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Xue-Yong Zhang
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Dan Wen
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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Harding R, Trnková P, Weston SJ, Lilley J, Thompson CM, Short SC, Loughrey C, Cosgrove VP, Lomax AJ, Thwaites DI. Benchmarking of a treatment planning system for spot scanning proton therapy: comparison and analysis of robustness to setup errors of photon IMRT and proton SFUD treatment plans of base of skull meningioma. Med Phys 2015; 41:111710. [PMID: 25370624 DOI: 10.1118/1.4897571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Base of skull meningioma can be treated with both intensity modulated radiation therapy (IMRT) and spot scanned proton therapy (PT). One of the main benefits of PT is better sparing of organs at risk, but due to the physical and dosimetric characteristics of protons, spot scanned PT can be more sensitive to the uncertainties encountered in the treatment process compared with photon treatment. Therefore, robustness analysis should be part of a comprehensive comparison between these two treatment methods in order to quantify and understand the sensitivity of the treatment techniques to uncertainties. The aim of this work was to benchmark a spot scanning treatment planning system for planning of base of skull meningioma and to compare the created plans and analyze their robustness to setup errors against the IMRT technique. METHODS Plans were produced for three base of skull meningioma cases: IMRT planned with a commercial TPS [Monaco (Elekta AB, Sweden)]; single field uniform dose (SFUD) spot scanning PT produced with an in-house TPS (PSI-plan); and SFUD spot scanning PT plan created with a commercial TPS [XiO (Elekta AB, Sweden)]. A tool for evaluating robustness to random setup errors was created and, for each plan, both a dosimetric evaluation and a robustness analysis to setup errors were performed. RESULTS It was possible to create clinically acceptable treatment plans for spot scanning proton therapy of meningioma with a commercially available TPS. However, since each treatment planning system uses different methods, this comparison showed different dosimetric results as well as different sensitivities to setup uncertainties. The results confirmed the necessity of an analysis tool for assessing plan robustness to provide a fair comparison of photon and proton plans. CONCLUSIONS Robustness analysis is a critical part of plan evaluation when comparing IMRT plans with spot scanned proton therapy plans.
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Affiliation(s)
- R Harding
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdomand Abertawe Bro Morgannwg University Health Board, Medical Physics and Clinical Engineering, Swansea SA2 8QA, United Kingdom
| | - P Trnková
- Paul Scherrer Institute, Centre for Proton Therapy, Villigen 5232, Switzerland
| | - S J Weston
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - J Lilley
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - C M Thompson
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - S C Short
- Leeds Institute of Molecular Medicine, Oncology and Clinical Research, Leeds LS9 7TF, United Kingdomand St James's Institute of Oncology, Oncology, Leeds LS9 7TF, United Kingdom
| | - C Loughrey
- St James's Institute of Oncology, Oncology, Leeds LS9 7TF, United Kingdom
| | - V P Cosgrove
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdom
| | - A J Lomax
- Paul Scherrer Institute, Centre for Proton Therapy, Villigen 5232, Switzerland
| | - D I Thwaites
- St James's Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdomand Institute of Medical Physics, School of Physics, University of Sydney, Sydney NSW 2006, Australia
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14
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Biau J, Khalil T, Verrelle P, Lemaire JJ. Fractionated radiotherapy and radiosurgery of intracranial meningiomas. Neurochirurgie 2015; 64:29-36. [PMID: 26100035 DOI: 10.1016/j.neuchi.2014.10.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 10/27/2014] [Accepted: 10/31/2014] [Indexed: 01/10/2023]
Abstract
This review focuses on the role of radiosurgery and fractionated radiotherapy in the management of intracranial meningiomas, which are the most common benign intracranial tumors. Whenever feasible, surgery remains a cornerstone of treatment in effective health care treatment where modern radiotherapy plays an important role. Irradiation can be proposed as first-line treatment, as adjuvant treatment, or as a second-line treatment after recurrence. Stereotactic radiosurgery consists of delivering, a high-dose of radiation with high precision, to the tumor in a single-fraction with a minimal exposure of surrounding healthy tissue. Stereotactic radiosurgery, especially with the gamma knife technique, has reached a high level of success for the treatment of intracranial meningiomas with excellent local control and low morbidity. However, stereotactic radiosurgery is limited by tumor size,<3-4cm, and location, i.e. reasonable distance from the organs at risk. Fractionated radiation therapy is an interesting alternative (5 to 6weeks treatment time) for large inoperable tumors. The results of fractionated radiation therapy seem encouraging as regards both local control and morbidity although long-term prospective studies are still needed.
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Affiliation(s)
- J Biau
- Centre Jean-Perrin, Département de Radiothérapie, 63000 Clermont-Ferrand, France
| | - T Khalil
- CHU de Clermont-Ferrand, Hôpital Gabriel-Montpied, Service de Neurochirurgie, 63003 Clermont-Ferrand, France
| | - P Verrelle
- Centre Jean-Perrin, Département de Radiothérapie, 63000 Clermont-Ferrand, France
| | - J-J Lemaire
- CHU de Clermont-Ferrand, Hôpital Gabriel-Montpied, Service de Neurochirurgie, 63003 Clermont-Ferrand, France.
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15
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Moyal L, Vignal-Clermont C, Boissonnet H, Alapetite C. [Results of fractionated targeted proton beam therapy in the treatment of primary optic nerve sheath meningioma]. J Fr Ophtalmol 2014; 37:288-95. [PMID: 24629446 DOI: 10.1016/j.jfo.2013.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/12/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Optic nerve sheath meningioma (ONSM) is a common benign neoplasm arising from the arachnoid tissue encapsulating the optic nerve and affects mainly middle aged women. It is a slow-growing tumor for which there is still no consensus on treatment. PURPOSE To evaluate the safety and efficacy of fractionated targeted proton beam therapy (PBT) in the treatment of ONSM and to define its role in the treatment of these tumors. METHODS AND MATERIALS We performed a retrospective analysis of 15 patients (13 women and 2 men), mean age 41.8 years, presenting with primary ONSM, followed at the Fondation Ophtalmologique Adolphe de Rothschild (Paris) between September 2006 and August 2013. After a multidisciplinary consultation, all were treated with PBT at a total dose of 52.2 Gy Eco, in fractions of 1.8 Gy Eco, at the Institut Curie (Paris). Patients underwent standardized follow-up including ophthalmologic examinations, visual field testing and imaging every 6 months. Study parameters were post-treatment visual acuity, tumor size on MRI, and treatment side effects RESULTS We separated the patients into 3 distinct groups: patients treated by PBT after an observation period (4/15), patients treated by PBT after primary surgery (5/15) and patients treated by PBT as primary treatment (6/15). Visual acuity improved in 3 cases, deteriorated in 1 and remained stable in 11 cases. Tumor size on MRI remained stable in 100 % of cases following PBT. No serious adverse effects were recorded after a mean follow-up of 22.4 months (8-79 months). CONCLUSION Our experience confirms the efficacy and the safety of proton beam therapy in patients with ONSM. PBT presents a promising alternative to surgery and conventional radiotherapy in the treatment of the MGNO. It seems to be effective in controlling tumor size and stabilizing visual function, at the cost of very low toxicity. Additional studies are needed to accurately determine the decision-making criteria and the ideal timing of this treatment.
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Affiliation(s)
- L Moyal
- Fondation ophtalmologique Adolphe-de-Rothschild, service des urgences et de neuro-ophtalmologie, 25, rue Manin, 75019 Paris, France.
| | - C Vignal-Clermont
- Fondation ophtalmologique Adolphe-de-Rothschild, service des urgences et de neuro-ophtalmologie, 25, rue Manin, 75019 Paris, France
| | - H Boissonnet
- Fondation ophtalmologique Adolphe-de-Rothschild, service de neuro-chirurgie, 25, rue Manin, 75019 Paris, France
| | - C Alapetite
- Campus universitaire d'Orsay, centre de protonthérapie, institut Curie (Orsay-Essonne), bâtiment 101, 15, rue Georges-Clemenceau, 91400 Orsay, France
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16
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Palau AEB, Morgan ML, Yalamanchili S, Lee AG. Neuro-Ophthalmology Annual Review. Asia Pac J Ophthalmol (Phila) 2014; 3:104-25. [PMID: 26107493 DOI: 10.1097/apo.0000000000000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to update the practicing ophthalmologist on the English-language neuro-ophthalmology literature from the prior year. This study is a review of English-language literature from August 1, 2012, to August 1, 2013. The authors searched PubMed articles published from August 1, 2012, to August 1, 2013, limited to English-language publications including original articles, review articles, and case reports and excluding letters to the editor, unpublished work, and abstracts. We researched the following topics: pupillary abnormalities, eye movement dysfunction, neuromuscular diseases, optic neuropathies, optic neuritis and demyelinating disease including multiple sclerosis, lesions of the chiasm and posterior primary visual pathways, elevated intracranial pressure, tumors and aneurysms affecting the visual pathways, vascular diseases, higher visual functions, and neuroimaging advances. We intend to share clinically relevant literature of the past year with the practicing ophthalmologist. We aimed to highlight remarkable and interesting literature rather than exhaustively including all new neuro-ophthalmological publications of the year. We reviewed literature in the past year with a focus on relevance and novelty. This review updates the comprehensive ophthalmologist on neuro-ophthalmic topics.
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Affiliation(s)
- Angelina Espino Barros Palau
- From the *Department of Ophthalmology, Houston Methodist Hospital, Houston, TX; †Baylor College of Medicine, Houston, TX; ‡Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX; §University of Texas Medical Branch, Galveston, TX; ¶University of Texas M.D. Anderson Cancer Center, Houston, TX; and ∥The University of Iowa Hospitals and Clinics, Iowa City, IA
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17
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Maclean J, Fersht N, Short S. Controversies in radiotherapy for meningioma. Clin Oncol (R Coll Radiol) 2013; 26:51-64. [PMID: 24207113 DOI: 10.1016/j.clon.2013.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/21/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
Meningiomas are the most common primary intracranial tumour. Although external beam radiotherapy and radiosurgery are well-established treatments, affording local control rates of 85-95% at 10 years, the evidence base is mainly limited to single institution case series. This has resulted in inconsistent practices. It is generally agreed that radiotherapy is an established primary therapy in patients requiring treatment for surgically inaccessible disease and postoperatively for grade 3 tumours. Controversy exists surrounding whether radiotherapy should be upfront or reserved for progression for incompletely excised and grade 2 tumours. External beam radiotherapy and radiosurgery have not been directly compared, but seem to offer comparable rates of control for benign disease. Target volume definition remains contentious, including the inclusion of hyperostotic bone, dural tail and surrounding brain, but pathological studies are shedding some light. Most agree that doses around 50-54 Gy are appropriate for benign meningiomas and ongoing European Organization for Research and Treatment of Cancer and Radiation Therapy Oncology Group studies are evaluating dose escalation for higher risk disease. Here we address the 'who, when and how' of radiotherapy for meningioma.
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Affiliation(s)
- J Maclean
- Department of Radiotherapy, University College London Hospitals NHS Trust, London, UK.
| | - N Fersht
- Department of Radiotherapy, University College London Hospitals NHS Trust, London, UK
| | - S Short
- Leeds Institute of Molecular Medicine, St James' University Hospital, Leeds, UK
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18
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Martin V, Moyal É, Delannes M, Padovani L, Sunyach MP, Feuvret L, Dhermain F, Noël G, Laprie A. Radiothérapie des tumeurs cérébrales : quelles marges ? Cancer Radiother 2013; 17:434-43. [DOI: 10.1016/j.canrad.2013.07.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 01/15/2023]
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