Neuro-ophthalmologic outcomes of standard versus hypo-fractionated stereotactic radiotherapy of AVPM

Leor Zach,Amir Agami,Ouzi Nissim,Iris Ben-Bassat Mizrachi,Guy Tam,Ruth Huna-Baron,Zion Zibly,Moshe Attia,Orit Furman,Roberto Spiegelmann,Zvi Cohen

doi:10.1186/s13014-021-01879-2

Abstract

BackgroundMost anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Due to location, most are treated non-surgically by fractionated stereotactic radiotherapy (FSRT), aiming to prevent tumor progression and visual functions deterioration. Unfortunately, FSRT in itself may affect visual functions. The current preferred treatment regimen (in terms of safety and effectiveness) is undetermined. While most cases are treated with conventional fractionation (cFSRT)—50.4–54 Gy in 28–30 fractions of 1.8–2 Gy, advances in technology have allowed shortening of total treatment length to hypofractionation (hSRT)—25-27 Gy in 3–5 fractions of 5–9 Gy. Our aim was to evaluate the association of radiotherapy regimen for treating AVPM (cFSRT vs. hSRT) with visual function outcomes (VA, VF) at the last neuro-ophthalmologic evaluation.MethodsWe conducted a retrospective cohort study of AVPM cases treated at Sheba Medical Center during 2004–2015. We compared cFSRT and hSRT regimens regarding visual function (VA, VF) outcomes at the last neuro-ophthalmologic evaluation. VA was determined by the logarithm of the minimum angle of resolution (LogMAR). VF was determined by the mean deviation (MD). A clinically relevant change in VA was defined as 0.2 LogMAR.Results48 patients (13 receiving hSRT, 35 receiving cFSRT) were included, with a median follow-up of 55 months. No significant difference was evident regarding LogMAR or MD of involved eyes at the last evaluation. Six (17%) patients in the cFSRT group experienced clinically relevant VA deterioration in the involved eye, compared with six (46%) in hSRT (p = 0.06).ConclusionOur findings, using comprehensive and meticulous investigation of visual outcomes, suggest that hSRT may be associated with higher risk for VA and VF deterioration in AVPM especially in ONSM. We recommend the use of cFSRT for ONSM.

Highlights

Anterior visual pathway meningioma (AVPM) in most cases are benign, slow growing World Health Organization (WHO) grade I tumors but may impair one or more visual functions: visual acuity (VA), visual field (VF), or color vision [1]
In light of the paucity of sufficiently detailed information, the present study investigated the relationship between the radiation therapy regimen and the change in visual function, measured at last neuro-ophthalmologic evaluation compared to pre-treatment
Patient population Patients were entered into analysis according to the following inclusion criteria: (1) patient received a radiological diagnosis of meningioma, (2) the tumor involved or was in anatomical proximity to one or more of the following locations: medial sphenoid wing; cavernous sinus; orbital apex; optic nerve sheath; tuberculum sella, (3) the tumor was treated with radiotherapy using Hypofraction‐ ated Stereotactic Radiotherapy (hSRT) or conventionally fractionated stereotactic radiotherapy (cFSRT) protocols at Sheba Medical Center during 2004– 2015, (4) data on neuro-ophthalmology and neuroimaging were available

Summary

Introduction

Anterior visual pathway meningioma (AVPM) in most cases are benign, slow growing WHO grade I tumors but may impair one or more visual functions: visual acuity (VA), visual field (VF), or color vision [1]. Most anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Most are treated nonsurgically by fractionated stereotactic radiotherapy (FSRT), aiming to prevent tumor progression and visual functions deterioration. While most cases are treated with conventional fractionation (cFSRT)—50.4–54 Gy in 28–30 fractions of 1.8–2 Gy, advances in technology have allowed shortening of total treat‐ ment length to hypofractionation (hSRT)—25-27 Gy in 3–5 fractions of 5–9 Gy. Our aim was to evaluate the associa‐ tion of radiotherapy regimen for treating AVPM (cFSRT vs hSRT) with visual function outcomes (VA, VF) at the last neuro-ophthalmologic evaluation Our aim was to evaluate the associa‐ tion of radiotherapy regimen for treating AVPM (cFSRT vs. hSRT) with visual function outcomes (VA, VF) at the last neuro-ophthalmologic evaluation

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