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Torres-Ríos JA, Rodríguez-Camacho A, Basilio-Tomé E, Meraz-Soto JM, Camacho-Ordonez A, Romero-Luna G, Gutierrez-Aceves GA, Olhovich IG, Celis-López MA, Hernández-Sánchez LC, Moreno-Jiménez S. Radiation therapy for optic nerve sheath meningiomas: Local control and treatment related visual changes. World Neurosurg X 2024; 23:100291. [PMID: 38523881 PMCID: PMC10958468 DOI: 10.1016/j.wnsx.2024.100291] [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: 04/03/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Objective Our primary objective is to evaluate the local control of optic nerve sheath meningiomas (ONSMs) treated with ionizing radiation and related visual changes after treatment. Our secondary objective is to describe the clinical characteristics and perform an analysis of the treatment impact on the functional status of this group of patients. Methods We present our series of 19 patients treated with ionizing radiation therapy at our radio-neurosurgery unit between 2016 and 2022. The setting, ophthalmological follow-up, morbidity, and survival are analyzed and discussed. Results Patients were followed up, and the impact of treatment on local disease control, visual alterations of the affected eye, and functional status of the patient were analyzed. The progression-free survival (PFS) median was 60 months (95% CI 50.3-69.6 months). The estimated PFS rates at 48 and 66 months were 100% and 66%, respectively. At diagnosis, nine (47.3%) eyes were in amaurosis and ten (52.6%) with vision. Of the ten patients without amaurosis at the time of diagnosis, three (30%) maintained unchanged visual acuity, and seven (70%) had decreased visual acuity; three of them developed amaurosis during the first year after treatment (p = 0.018). Conclusions Using ionizing radiation therapy is a successful treatment for the local control of ONSMs. This therapeutic modality can compromise the visual acuity of the affected eye and improve dyschromatopsia and campimetry defects. The life prognosis is good for these patients, with a zero mortality rate, but their vision prognosis is poor.
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Affiliation(s)
- Jorge Alejandro Torres-Ríos
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Alejandro Rodríguez-Camacho
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Radiotherapy Department of Oncology Hospital, XXI Century Mexican Institute of Social Security, Mexico City, Mexico
| | - Estefania Basilio-Tomé
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Juan Marcos Meraz-Soto
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Azyadeh Camacho-Ordonez
- Neuro-Ophthalmology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Gerardo Romero-Luna
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Guillermo Axayacatl Gutierrez-Aceves
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Irene González Olhovich
- Neuro-Ophthalmology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Miguel Angel Celis-López
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | | | - Sergio Moreno-Jiménez
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- American British Cowdray Medical Center, Cancer Center, Mexico City, 01120, Mexico
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Wei Z, Taori S, Song S, Deng H, Niranjan A, Lunsford LD. Does Adjuvant Gamma Knife Stereotactic Radiosurgery Have a Role in Treating Optic Nerve Sheath Meningiomas? J Neuroophthalmol 2024; 44:195-200. [PMID: 37410926 DOI: 10.1097/wno.0000000000001914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Meningiomas arising from or adjacent to the optic nerve sheath meningioma (ONSM) are management challenges because of their risk of visual loss. Stereotactic radiosurgery (SRS) is a minimally invasive modality that can be added as adjuvant treatment for patients whose tumor has progressed or recurred after initial resection. METHODS The authors retrospectively reviewed 2,030 meningioma patients who underwent SRS between 1987 and 2022. In total, 7 patients (4 females; median age = 49) were found with tumors originating from the optic nerve sheath. None of the patients had tumors that engulfed the optic nerve as such tumors typically undergo fractionated radiation therapy (FRT) to preserve vision. The clinical history, visual function, and radiographic and neurological findings were characterized. Outcome measures included visual status, tumor control, and the need for additional management. RESULTS All patients underwent either initial gross total (n = 1) or partial surgical resection (n = 6) before SRS. Two patients with progressive tumor growth also had SRS after failing additional fractionated radiation after surgery (54 Gy, 30 fractions for both patients). The median time between the date of surgery and the SRS procedure date was 38 months. The Leksell Gamma Knife was used to deliver a margin dose of 12 Gy (range: 8-14 Gy) to a median cumulative tumor volume of 3.3 cc (range: 1.2-18 cc). The median maximal optic nerve radiation dose was 6.5 Gy (range: 1.9-8.1 Gy). After SRS, the median follow-up time was 130 months (range: 26-169 months). Two patients showed local tumor progression at 20 and 55 months after SRS. Four had stable visual function, 2 experienced improved visual acuity, and 1 patient had visual deterioration. CONCLUSIONS Meningiomas arising from (but not engulfing the optic nerve) represent management quandaries after failed initial surgical removal. In this experience, salvage SRS was associated with tumor control and vision preservation in 5 of 7 patients. Additional experience with this strategy may further define the role of SRS both as a salvage and primary option.
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Affiliation(s)
- Zhishuo Wei
- Departments of Neurological Surgery (ZW, HD, AN, LDL) and Neurology (SS), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Pittsburgh School of Medicine (ZW, ST), Pittsburgh, Pennsylvania
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Koç İ, Yüce Sarı S, Yazıcı G, Kapucu Y, Kıratlı H, Zorlu F. Role of hypofractionated stereotactic radiotherapy for primary optic nerve sheath meningioma. Neurooncol Pract 2024; 11:150-156. [PMID: 38496921 PMCID: PMC10940822 DOI: 10.1093/nop/npad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Optic nerve sheath meningiomas (ONSM) are rare tumors potentially causing visual deficits. This study aims to report the anatomic and visual outcomes of patients with primary ONSM treated with hypofractionated stereotactic radiotherapy (HF-SRT). Methods Data of 36 patients treated with HF-SRT between 2008 and 2019 were retrospectively collected. The clinical target volume (CTV) was equal to the gross tumor volume and a 2 mm was added for the planning target volume. All responses other than progression were accepted as local control (LC). The VA grading was performed under 3 groups to provide an even distribution; 20/400 or worse, 20/40-20/400, and 20/40 or better. Results Median HF-SRT dose was 25 Gy and the median CTV was 1.94 cc. After a median of 106 months of follow-up, the tumor regressed in 23 (64%), was stable in 9 (25%), and progressed in 4 (11%) eyes. The overall rate of LC was 89% with 2-, 5-, 10-, and 15-year rate of 100%, 94%, 84%, and 84%, respectively. Treatment-related late toxicity rate was 11%. The VA was stable in 27 (75%) eyes, improved in 5 (14%) eyes, and worsened in 4 (11%) eyes, respectively, after HF-SRT. Female gender was the only independent predictor of an improved VA. Conclusions Hypofractionated stereotactic radiotherapy is a safe and satisfactory treatment option for primary ONSM without severe toxicity. It may be advisable to commence treatment before an established visual deficit of 20/400 or worse occurs, to make the most of the functional benefit.
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Affiliation(s)
- İrem Koç
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sezin Yüce Sarı
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gözde Yazıcı
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yasemin Kapucu
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hayyam Kıratlı
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Faruk Zorlu
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
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Tang T, Wang J, Lin T, Zhai Z, Song X. The treatment efficacy of radiotherapy for optic nerve sheath meningioma. Eye (Lond) 2024; 38:89-94. [PMID: 37349547 PMCID: PMC10764342 DOI: 10.1038/s41433-023-02640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES Optic nerve sheath meningioma (ONSM) is a rare benign tumour that accounts for approximately 2% of all orbital tumours. Radiotherapy has gradually become an important treatment for ONSM because of its good effect in preserving or improving vision. We aimed to explore the effect of radiotherapy on tumour control and vision preservation/improvement in patients with ONSM. METHODS Forty-three patients with primary ONSM treated in our institution from 2015 to 2021 were enrolled. The irradiation dose was from 50.4 to 54 Gy with 28-30 fractions. We evaluated the tumour volume on MRI or CT, and visual acuity before and after the radiotherapy. RESULTS Thirty-four patients (79%) experienced a vision decrease at diagnosis. The mean duration of follow-up was 54.1 months (ranges: 18-93, median: 56). Among 25 patients who had tumour evaluation using MRI, 16 patients (37.2%) showed stable tumours, 7 patients (16.3%) had tumour shrinkage, but 2 patients (4.7%) experienced tumour progression. Among the 39 patients performing vision acuity evaluation, 16 patients (37.2%) had vision improvement or recovery. 16 of the 23 patients without vision improvement demonstrated severe visual loss at diagnosis. Two patients had evidence of tumour progression during the follow-up. Additionally, 4 (10.2%) patients had dry eyes, 7 (17.9%) patients experienced watery eyes, and 3 (7.7%) patients had eye swelling. Patients with vision loss for more than 12 months had a lower possibility of vision recovery than those with vision loss for less than 12 months. CONCLUSIONS Radiotherapy such as IMRT, VMAT, and 3D-CRT plays an important role in the treatment of ONSM. The probability of vision recovery is lower in patients with severe vision loss at diagnosis or the duration of vision loss is more than 12 months.
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Affiliation(s)
- Tianci Tang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jie Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Tong Lin
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Zhoushijia Zhai
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Xinmao Song
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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Hussain ZS, Loya A, Riaz KM, Lee AG. Optic Nerve Sheath Meningiomas: A National Surveillance, Epidemiology, and End Results (SEER) Database Analysis. J Neuroophthalmol 2023:00041327-990000000-00539. [PMID: 38127446 DOI: 10.1097/wno.0000000000002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Optic nerve sheath meningioma (ONSM) is a rare optic nerve cancer with considerable morbidity. This national analysis validates previously known ONSM concepts while providing insight into novel risk factors. METHODS The Surveillance, Epidemiology, and End Results (SEER) Program was queried from 2000 to 2019 for all histologic subtypes of meningioma primary to the optic nerve. Relevant clinical and demographic variables were analyzed. Asymptotic one-sample test for binomial proportions and Cox proportional hazards modeling evaluated the significance of factor associations. RESULTS A total of 51 ONSM cases were extracted. A greater proportion of cases were observed in females (N = 37, 73%, P < 0.001) and individuals with age 50 years or more (N = 29, 57%, P < 0.001); the mean number of months from diagnosis to treatment was 4.6 months (SD 4.1, range 13). Psychosocial epidemiologic parameter analysis demonstrated a greater proportion of patients with married status on diagnosis (N = 31, 61%, P < 0.001), listed total family income between $55,000 and $74,999 (N = 24, 47%, P < 0.001). Relative to cases diagnosed clinically only, cases diagnosed radiologically without microscopic confirmation experienced decreased all-cause mortality (HR = 0.041, P = 0.050). CONCLUSIONS Our SEER national analysis affirms previously characterized ONSM concepts. Upon ONSM diagnosis and if needed, treatment protocols are not significantly delayed. Novel psychosocial factors for ONSM were identified, including marital status, total family income, and non-Hispanic white race. Additional ONSM diagnostics may reduce longitudinal mortality burden.
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Affiliation(s)
- Zain S Hussain
- Dean McGee Eye Institute (ZSH, KMR), Oklahoma City, Oklahoma; University of Medicine and Health Sciences (ZSH), Basseterre, Saint Kitts and Nevis; Department of Ophthalmology (AL), Baylor College of Medicine, Houston, Texas; Center for Space Medicine (AGL), Baylor College of Medicine, Houston, Texas; The Houston Methodist Research Institute (AGL), Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A&M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa
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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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Martz N, Salleron J, Dhermain F, Vogin G, Daisne JF, Mouttet-Audouard R, Tanguy R, Noel G, Peyre M, Lecouillard I, Jacob J, Attal J, Charissoux M, Veresezan O, Hanzen C, Huchet A, Latorzeff I, Coutte A, Doyen J, Stefan D, Feuvret L, Garcia GCTE, Royer P. Target volume delineation for radiotherapy of meningiomas: an ANOCEF consensus guideline. Radiat Oncol 2023; 18:113. [PMID: 37408055 DOI: 10.1186/s13014-023-02300-w] [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: 02/13/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE Radiotherapy is, with surgery, one of the main therapeutic treatment strategies for meningiomas. No prospective study has defined a consensus for the delineation of target volumes for meningioma radiotherapy. Therefore, target volume definition is mainly based on information from retrospective studies that include heterogeneous patient populations. The aim is to describe delineation guidelines for meningioma radiotherapy as an adjuvant or definitive treatment with intensity-modulated radiation therapy and stereotactic radiation therapy techniques. This guideline is based on a consensus endorsed by a multidisciplinary group of brain tumor experts, members of the Association of French-speaking Neuro-oncologists (ANOCEF). MATERIALS AND METHODS A 3-step procedure was used. First, the steering group carried out a comprehensive review to identify divergent issues on meningiomas target volume delineation. Second, an 84-item web-questionnaire has been developed to precisely define meningioma target volume delineation in the most common clinical situations. Third, experts members of the ANOCEF were requested to answer. The first two rounds were completed online. A third round was carried out by videoconference to allow experts to debate and discuss the remaining uncertain questions. All questions remained in a consensus. RESULTS Limits of the target volume were defined using visible landmarks on computed tomography and magnetic resonance imaging, considering the pathways of tumor extension. The purpose was to develop clear and precise recommendations on meningiomas target volumes. CONCLUSION New recommendations for meningiomas delineation based on simple anatomic boundaries are proposed by the ANOCEF. Improvement in uniformity in target volume definition is expected.
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Affiliation(s)
- Nicolas Martz
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France.
| | - Julia Salleron
- Cellule Data-biostatistiques, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lés-Nancy, France
| | - Frédéric Dhermain
- Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France
| | - Guillaume Vogin
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France
- Department of Radiation Therapy, Baclesse Radiation Therapy Centre, Esch/Alzette, Luxembourg
| | - Jean-François Daisne
- Department of Radiation Oncology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | | | - Ronan Tanguy
- Department of Radiotherapy, Léon Bérard Cancer Centre, Lyon, France
| | - Georges Noel
- Radiation Oncology Department, Paul Strauss Cancer Centre, Strasbourg, France
| | - Matthieu Peyre
- Department of Neurosurgery, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Julian Jacob
- Department of Radiation Oncology, Hôpital Pitié-Salpêtrière Charles Foix, APHP, Paris, France
| | - Justine Attal
- Radiotherapy Department, Institut Claudius Regaud, Toulouse University Institute for Cancer (IUCT-Oncopole), Toulouse, France
| | - Marie Charissoux
- Radiation Oncology Department, Centre Val d'Aurelle, Montpellier, France
| | - Ovidiu Veresezan
- Department of Radiation Oncology, Cancer Centre Henri Becquerel, Rouen, France
| | - Chantal Hanzen
- Department of Radiation Oncology, Centre Hospitalier et Universitaire, Bordeaux, France
| | - Aymeri Huchet
- Department of Radiation Oncology, Centre Hospitalier et Universitaire, Bordeaux, France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD Garonne and Clinique Pasteur, Toulouse, France
| | | | - Jérôme Doyen
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice- Sophia, Nice, France
| | - Dinu Stefan
- Department of Radiation Oncology, François Baclesse Cancer Centre, Caen, France
| | - Loic Feuvret
- Department of Radiation Oncology, Hôpital Pitié-Salpêtrière Charles Foix, APHP, Paris, France
| | | | - Philippe Royer
- Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine - Alexis-Vautrin Cancer Center, 6 avenue de Bourgogne - CS 30 519, Vandoeuvre Les Nancy, France
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Vandebroek AC, Erokhina M, Boden K, Szurman P, Rickmann A. [Misleading diagnosis of papilledema]. DIE OPHTHALMOLOGIE 2022; 119:1294-1298. [PMID: 35179624 DOI: 10.1007/s00347-022-01589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Anne-Cécile Vandebroek
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland.
| | - Mariya Erokhina
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Karl Boden
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Annekatrin Rickmann
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
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Carey AR, Page BR, Miller N. Radiation-induced optic neuropathy: a review. Br J Ophthalmol 2022; 107:743-749. [DOI: 10.1136/bjo-2022-322854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
Radiation is a commonly used treatment modality for head and neck as well as CNS tumours, both benign and malignant. As newer oncology treatments such as immunotherapies allow for longer survival, complications from radiation therapy are becoming more common. Radiation-induced optic neuropathy is a feared complication due to rapid onset and potential for severe and bilateral vision loss. Careful monitoring of high-risk patients and early recognition are crucial for initiating treatment to prevent severe vision loss due to a narrow therapeutic window. This review discusses presentation, aetiology, recent advances in diagnosis using innovative MRI techniques and best practice treatment options based on the most recent evidence-based medicine.
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Vanikieti K, Chaiwithooanukul C, Puataweepong P, Jindahra P, Padungkiatsagul T. Long-Term Visual Function After Fractionated Stereotactic Radiotherapy for Primary Optic Nerve Sheath Meningioma: A Retrospective Analysis of 34 Subjects. Clin Ophthalmol 2022; 16:3119-3128. [PMID: 36172493 PMCID: PMC9512281 DOI: 10.2147/opth.s383702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate long-term visual function after fractionated stereotactic radiotherapy (FSRT) for primary optic nerve sheath meningioma (PONSM). Methods This 22-year retrospective study included 34 subjects (34 affected eyes) with PONSM who were treated with FSRT exclusively. Subjects with a history of biopsy/resection were excluded. Visual function, including visual acuity (VA) and visual field mean deviation (VF MD), was evaluated at presentation (pre-radiotherapy; pre-RT) and at the final follow-up (post-radiotherapy; post-RT); treatment complications were also evaluated. Treatment success was defined as either stabilization or improvement of visual function. Results The median pre-RT VA and pre-RT VF MD were 0.70 logarithm of the minimum angle of resolution (logMAR; range: 0.0–2.9 logMAR) and −15.4 decibels (dB) (range: −31.4 to −3.2 dB), respectively. The median total dose of FSRT was 50 Gy (range: 45–54 Gy) and the median number of fractions was 25 (range: 25–30). The median follow-up interval was 89 months (range: 6–251 months). The median post-RT VA and post-RT VF MD were 0.48 logMAR (range: 0.0–2.9 logMAR) (p = 0.010) and −6.8 dB (range: −20.6 to −1.6 dB) (p = 0.005), respectively. Among the 34 included eyes, VA was successfully treated in 29 eyes (85.3%) and worsened in 5 eyes (14.7%). Of the 14 eyes with both VA and reliable VF MD at pre-RT and post-RT time points, VF MD was successfully treated in 13 eyes (92.8%) and worsened in one (7.2%); overall visual function was successfully treated in 13 eyes (92.8%) and worsened in 1 eye (7.2%). Complications occurred in one subject (2.9%; radiation retinopathy). Conclusion Approximately 90% of PONSM subjects exhibited long-term treatment success in terms of VA, VF MD, and overall visual function after FSRT. Additionally, the incidence of complications was low. Therefore, FSRT is effective and safe treatment for PONSM.
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Affiliation(s)
- Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Putipun Puataweepong
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Tanyatuth Padungkiatsagul, Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand, Tel +662 201 1526, Email
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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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Mesny E, Jacob J, Culot F, Calugaru V, Jenny C, Fonti B, Bourdais R, Courtault-Deslandes F, Boulle G, Meillan N, Simon JM, Maingon P, Feuvret L. Optic nerve motion and gaze direction: Their impact on intraorbital tumor radiotherapy. Cancer Radiother 2022; 26:678-683. [DOI: 10.1016/j.canrad.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
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13
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Du QH, Li J, Gan YX, Zhu HJ, Yue HY, Li XD, Ou X, Zhong QL, Luo DJ, Xie YT, Liang QF, Wang RS, Liu WQ. Potential Defects and Improvements of Equivalent Uniform Dose Prediction Model Based on the Analysis of Radiation-Induced Brain Injury. Front Oncol 2022; 11:743941. [PMID: 35087743 PMCID: PMC8786722 DOI: 10.3389/fonc.2021.743941] [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: 07/20/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To study the impact of dose distribution on volume-effect parameter and predictive ability of equivalent uniform dose (EUD) model, and to explore the improvements. METHODS AND MATERIALS The brains of 103 nasopharyngeal carcinoma patients treated with IMRT were segmented according to dose distribution (brain and left/right half-brain for similar distributions but different sizes; V D with different D for different distributions). Predictive ability of EUDV D (EUD of V D ) for radiation-induced brain injury was assessed by receiver operating characteristics curve (ROC) and area under the curve (AUC). The optimal volume-effect parameter a of EUD was selected when AUC was maximal (mAUC). Correlations between mAUC, a and D were analyzed by Pearson correlation analysis. Both mAUC and a in brain and half-brain were compared by using paired samples t-tests. The optimal D V and V D points were selected for a simple comparison. RESULTS The mAUC of brain/half-brain EUD was 0.819/0.821 and the optimal a value was 21.5/22. When D increased, mAUC of EUDV D increased, while a decreased. The mAUC reached the maximum value when D was 50-55 Gy, and a was always 1 when D ≥55 Gy. The difference of mAUC/a between brain and half-brain was not significant. If a was in range of 1 to 22, AUC of brain/half-brain EUDV55 Gy (0.857-0.830/0.845-0.830) was always larger than that of brain/half-brain EUD (0.681-0.819/0.691-0.821). The AUCs of optimal dose/volume points were 0.801 (brain D2.5 cc), 0.823 (brain V70 Gy), 0.818 (half-brain D1 cc), and 0.827 (half-brain V69 Gy), respectively. Mean dose (equal to EUDV D with a = 1) of high-dose volume (V50 Gy-V60 Gy) was superior to traditional EUD and dose/volume points. CONCLUSION Volume-effect parameter of EUD is variable and related to dose distribution. EUD with large low-dose volume may not be better than simple dose/volume points. Critical-dose-volume EUD could improve the predictive ability and has an invariant volume-effect parameter. Mean dose may be the case in which critical-dose-volume EUD has the best predictive ability.
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Affiliation(s)
- Qing-Hua Du
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Li
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Xiu Gan
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui-Jun Zhu
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai-Ying Yue
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiang-De Li
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xue Ou
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qiu-Lu Zhong
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan-Jing Luo
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Ting Xie
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qian-Fu Liang
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ren-Sheng Wang
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wen-Qi Liu
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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14
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de Melo LP, Arruda Viani G, de Paula JS. Radiotherapy for the treatment of optic nerve sheath meningioma: A systematic review and meta-analysis. Radiother Oncol 2021; 165:135-141. [PMID: 34688809 DOI: 10.1016/j.radonc.2021.10.009] [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: 12/08/2020] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The management of Optic Nerve Sheath Meningiomas (ONSM) has suffered a significant shift due to new radiation techniques. However, there is no conclusive information on which approach presents better results in the literature. This meta-analysis aims to evaluate the outcomes of different radiotherapy (RT) modalities in the management of ONSM. METHODS A systematic review based on an electronic search was performed in MEDLINE, EMBASE, Cochrane, and Lilacs databases. Eligible studies included patients with ONSM treated with RT. Two reviewers independently assessed the eligibility of potential studies, extracted data, and performed the meta-analysis. Outcomes of interest were tumor control, visual acuity (VA), visual field, and complications. RESULTS Thirty-nine non-comparative studies involving 736 eyes with ONSM treated with RT were included. Six different techniques were studied: 2-dimensional RT (2DRT), 3D-conformal RT (3CRT), Stereotactic Fractionation RT (SFRT), stereotactic radiosurgery (SRS), intensity-modulated RT (IMRT), and proton beam therapy (PBT). With a mean follow-up period of 46 months, tumor control was 97,4% (95% CI: 98-100%). No difference was observed regarding the rate of final VA post-treatment among the modalities. The 3CRT showed substantially higher rates of complication than other techniques. CONCLUSIONS RT produces remarkable tumor control. New radiation modalities such as SFRT, IMRT, SRS, and PBT resulted in better therapeutic results with fewer complications than 2DRT and 3CRT. Thus, they should be the preferential choices for treating ONSM regardless of initial clinical presentation.
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Affiliation(s)
- Laísa Pereira de Melo
- Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Arruda Viani
- Department of Image Sciences and Medical Physics, Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.
| | - Jayter Silva de Paula
- Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil
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15
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Sharieff JA, Melson A, Algan O. Treatment of Recurrent Optic Nerve Sheath Meningioma With a Secondary Course of Radiotherapy. Cureus 2021; 13:e17935. [PMID: 34660125 PMCID: PMC8513540 DOI: 10.7759/cureus.17935] [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] [Accepted: 09/13/2021] [Indexed: 12/02/2022] Open
Abstract
Optic nerve sheath meningiomas (ONSM) are benign neoplasms found surrounding the optic nerve that can affect vision, and potentially lead to blindness. The use of radiotherapy has been advocated to improve visual outcomes and minimize the risk of complications. We present a case of a 58-year-old woman who was treated with a second course of radiotherapy 27-years after initial radiotherapy for recurrent ONSM. The patient responded well to the second course of radiotherapy with good clinical and visual outcomes. This case report supports evidence that treatment with radiotherapy can improve visual outcomes in patients with recurrent ONSM with mild to moderate re-irradiation-related side effects.
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Affiliation(s)
- Jibran A Sharieff
- Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Andrew Melson
- Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Ozer Algan
- Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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16
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Hage R, Alapetite C, Brisse H, Zuber K, Lecler A, Lot G, Le Guerinel C, Vignal-Clermont C, Boissonnet H. Efficacy and Safety of Proton Beam Therapy for Primary Optic Nerve Sheath Meningioma. Eye Brain 2021; 13:219-229. [PMID: 34466049 PMCID: PMC8402992 DOI: 10.2147/eb.s305822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Management of optic nerve sheath meningiomas (ONSM) remains challenging. Photon radiation therapy (PhRT) is the most common treatment for sight-threatening ONSM. Proton beam therapy (PBT) is less commonly used because it is more expensive and because there are questions about its efficacy specifically in relation to ONSM. PBT has the theoretical advantage of reducing radiation exposure to adjacent structures. We report the visual outcome of patients with primary ONSM managed at the Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, and treated with PBT at the Centre de Protonthérapie, Institut Curie, Orsay, France. Methods We conducted a retrospective review of all patients with primary ONSM who received PBT (either by itself or following surgery) between January 2006 and January 2019. Neuro-ophthalmic examinations were performed at presentation and after radiotherapy, and, when applicable, after surgery. Meningiomas were measured at the time of diagnosis and at each follow-up MRI examination. Results Sixty patients (50 women, 10 men; mean age, 45.2±11.1y) were included, of whom 29 underwent surgery. At presentation, 52 (87%) of them had decreased vision (average visual acuity: 0.6 logMAR). Fundus examination showed optic disc swelling (n=27; 46.5%), optic disc pallor (n=22; 37.9%), optic disc cupping (n=2; 3.4%), opto-ciliary shunt (n=8; 13.8%), or choroidal folds (n=5; 8.6%). Otherwise, it was unremarkable (n=7; 12.1%). After treatment, visual function was stable overall. Fundus examination showed pallor (n=47; 83.9%), swelling (n=3; 5.4%), or cupping (n=2; 3.4%) of the optic disc, or was unremarkable (n=5; 8.9%). The visual field of 8 patients worsened, while 3 developed asymptomatic retinal hemorrhages. Tumor shrunk significantly in 8 patients at 1 year after PBT and remained stable in size in all others. Patients with opto-ciliary shunts had significantly worse visual outcome than other patients. Retinal abnormalities were observed in 11 patients during follow-up. Conclusion PBT alone or in association with surgery appears to be a safe and efficient treatment for ONSM, reducing the tumor size and stabilizing visual function. The risk of developing radiation retinopathy seems to be higher when patients had upfront surgery.
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Affiliation(s)
- Rabih Hage
- Neuro-ophthalmology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Claire Alapetite
- Radiation Oncology Department, and Proton Center Institut Curie, Paris-Orsay, France
| | - Hervé Brisse
- Imaging Department, Institut Curie, Paris, France.,Université des Sciences et Lettres, Paris, France
| | - Kevin Zuber
- Department of Statistics and Clinical Research, Hôpital Fondation A. de Rothschild, Paris, France
| | - Augustin Lecler
- Radiology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Guillaume Lot
- Neurosurgery Department, Hôpital Fondation A. de Rothschild, Paris, France
| | | | | | - Herve Boissonnet
- Neurosurgery Department, Hôpital Fondation A. de Rothschild, Paris, France
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17
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68Ga-DOTATOC-PET/MRI-A Secure One-Stop Shop Imaging Tool for Robotic Radiosurgery Treatment Planning in Patients with Optic Nerve Sheath Meningioma. Cancers (Basel) 2021; 13:cancers13133305. [PMID: 34282752 PMCID: PMC8267930 DOI: 10.3390/cancers13133305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Optic nerve sheath meningiomas (ONSM) are rare but can lead to irreversible blindness. Hybrid imaging may enhance tumor delineation and diagnostic accuracy via receptor binding. However, relevant clinical data for ONSM are lacking. We evaluated the feasibility of receptor-based hybrid imaging prior to robotic radiosurgery (RRS). We retrospectively analyzed all of our institution's patients with suspected ONSM who underwent combined positron emission tomography and magnetic resonance imaging (PET/MRI) with gallium-68-labeled (DOTA0-Phe1-Tyr3) octreotide (Ga68-DOTATOC) before RRS between 2018 and 2019. Eight patients with ten suspected ONSM (female = 7; median age, 51.2 years; IQR, 43.0-66.0) were included. Nine out of ten ONSM were deemed PET-positive with a median standard uptake value (SUV) max of 5.6 (IQR, 2.6-7.8). For all nine ONSM that presented 68Ga-DOTATOC uptake, hybrid PET/MRI was used for target volume contouring prior to RSS. At a median follow-up of 11.7 months (IQR, 9.4-16.4), tumor control was achieved in all patients. Radiosurgery resulted in the improvement of visual acuity in two of eight patients, whereas six showed stable vision. Ga68-DOTATOC-PET/MRI can be used for target volume contouring prior to RRS for ONSM as it enables safe treatment planning and improves diagnostic accuracy.
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18
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Senger C, Kluge A, Kord M, Zimmermann Z, Conti A, Kufeld M, Kreimeier A, Loebel F, Stromberger C, Budach V, Vajkoczy P, Acker G. Effectiveness and Safety of Robotic Radiosurgery for Optic Nerve Sheath Meningiomas: A Single Institution Series. Cancers (Basel) 2021; 13:cancers13092165. [PMID: 33946405 PMCID: PMC8125730 DOI: 10.3390/cancers13092165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Optic nerve sheath meningiomas (ONSM) are a rare subtype of meningioma. Only four retrospective studies with 3–21 patients have been published on the treatment of ONSM by radiosurgery. This study represents the largest published series on robotic radiosurgery to date, treating 25 patients with 27 ONSM lesions. Furthermore, hypofractionated radiosurgical treatment proves to be a safe alternative to surgery and fractionated stereotactic radiation with an overall local tumor control rate of 96.0% and stable or improved visual acuity in 90.0% and 10.0% of patients, respectively. We believe that our study makes a significant contribution to the literature, as our results indicate that robotic radiosurgery is a safe and effective treatment for the management of ONSM and offers a potential treatment option that would improve patient care and clinical outcomes. Abstract The role of robotic radiosurgery (RRS) in the treatment of optic nerve sheath meningiomas (ONSM) remains controversial and it is only performed in specialized institutions due to tight dose constraints. We evaluated the effectiveness and safety of RRS in the management of ONSM. Twenty-five patients with 27 ONSM lesions who underwent RRS using the Cyberknife (CK) system were retrospectively analyzed (median age, 47.9 years; 84.0% women). Multisession RRS was used with 4–5 fractions with a cumulative dose of 20.0–25.0 Gy in 84.0% of patients and a single fraction at a dose of 14.0–15.0 Gy in 16% of patients. Prior to RRS, seven (28%) patients experienced blindness on the lesion side. In those patients with preserved vision prior to radiosurgery, the visual acuity remained the same in 90.0% and improved in 10.0% of the patients. Overall local tumor control was 96.0% (mean follow-up period; 37.4 ± 27.2 months). Neither patient age, previous surgery, or the period from the initial diagnosis to RRS showed a dependency on visual acuity before or after radiosurgery. RRS is a safe and effective treatment for the management of ONSM. Hypofractionation of radiosurgery in patients with preserved vision before CK treatment results in stable or improved vision.
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Affiliation(s)
- Carolin Senger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Correspondence: ; Tel.: +49-30-450-557221
| | - Anne Kluge
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Melina Kord
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Zoe Zimmermann
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Alfredo Conti
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Via Altura 3, 40139 Bologna (BO), Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna (BO), Italy
| | - Markus Kufeld
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Anita Kreimeier
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Franziska Loebel
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Peter Vajkoczy
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Gueliz Acker
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health at Charité Universitätsmedizin Berlin, BIH Acadamy, Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
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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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20
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Prognostic Factors for Functional Outcome of Patients with Optic Nerve Sheath Meningiomas Treated with Stereotactic Radiotherapy-Evaluation of Own and Meta-Analysis of Published Data. Cancers (Basel) 2021; 13:cancers13030522. [PMID: 33572990 PMCID: PMC7866383 DOI: 10.3390/cancers13030522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/17/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary This article highlights the fractionated stereotactic radiotherapy in the treatment of optic nerve sheath meningioma (ONSM). ONSM, a slow-growing tumor next to the optic nerve, causes over a long period partial or complete blindness. As visual impairments appear and progress slowly in the disease history, the need for treatment and treatment starting time are controversial. We restate in our article that fractionated stereotactic radiotherapy improves visual function. We further search for prognostic factors which might provide valuable additional and independent information on when to start treatment. We reveal that the visual acuity is a prognostic factor for the outcome of stereotactic therapy for ONSM and promote it as a biomarker for the decision for treatment initiation. Abstract Objective: To evaluate prognostic factors for a favorable outcome (improvement of the visual acuity or visual fields) after fractionated stereotactic radiotherapy (fSRT) of optic nerve sheath meningioma (ONSM). Methods: We performed a database search for ONSM treatments during the period from April 2008 to September 2019 in the prospective database for stereotactic radiosurgery/radiotherapy (SRS/SRT) of the Robert Janker Clinic Bonn (Department of Radiotherapy) and performed a literature review and meta-analysis of published data on ONSM between 2010 and 2019. Ophthalmic status before and after treatment was evaluated and the collective was dichotomized into two groups: functional improvement (FI; improvement of either visual acuity or visual fields) and non functional improvement (NFI; with stable or deteriorating visual acuity or visual fields). The two groups were compared regarding different variables: pretreatment visual acuity, age, gender, gross tumor volume (GTV), follow up (FU) time, tumor localization, and maximal retina dose. Results: Overall, 13 stereotactic radiotherapies were performed for ONSM (12 × fSRT, 1 × SRS). Mean follow up was 3 years (range: 1–5 years). The total dose was 50.4 Gy (5 × 1.8 Gy/week) in 12 patients treated with fSRT and 1 × 14 Gy in one SRS case. Mean GTV was 1.13 ccm (range: 0.44–2.20 ccm). During follow up, all tumors were stable or showed shrinkage of tumor volume (100% tumor control), no adverse events were observed, 53% of the patients achieved either better visual acuity or visual fields. Pretreatment visual acuity was significantly different between the FI and the NFI group (0.17 vs. 0.63, p = 0.03) in our series and in the meta analysis (p < 0.01). Moreover, shorter FU time and lower retinal dose were significantly linked (p < 0.05 and p < 0.01, respectively) with a better outcome in the meta-analysis but not in our patient cohort. Intracranial tumor localization, gender, and age were not significantly different between the two outcome groups. Conclusion: FSRT for ONSM achieves in over 50% of cases an improvement of the ophthalmic status with low morbidity and excellent tumor control in our series and the meta analysis. Patients with a favorable outcome had in all analysis a significantly higher visual acuity before treatment start. Therefore, we advocate using fSRT as early as possible before vision deterioration occurs.
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Eckert F, Clasen K, Kelbsch C, Tonagel F, Bender B, Tabatabai G, Zips D, Thorwarth D, Frey B, Becker G, Wilhelm H, Paulsen F. Correction to: Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas. Radiat Oncol 2020; 15:268. [PMID: 33213504 PMCID: PMC7677773 DOI: 10.1186/s13014-020-01706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Franziska Eckert
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Kerstin Clasen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Carina Kelbsch
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Felix Tonagel
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Centre for Neurooncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Bettina Frey
- Department of Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Gerd Becker
- RadioChirurgicum, CyberKnife Suedwest, Klinik Am Eichert, Eichertstr. 3, 73035, Goeppingen, Germany
| | - Helmut Wilhelm
- Department for Ophthalmology, Eberhard-Karls-University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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