Abstract
PurposeWe analyzed our long-term experience with fractionated stereotactic radiotherapy (FSRT) in patients with meningioma of the optic nerve sheath (ONSM).Patients and MethodsBetween January 1991 and January 2010, 40 patients with ONSM were treated using FSRT. Of these, 19 patients received radiotherapy as primary treatment, and 21 patients were treated after surgical resection. The median target volume was 9.2 ml, median total dose was 54 Gy in median single fractions of 1,8 Gy.ResultsLocal progression-free survival was 100%. Median survival after FSRT was 60 months (range 4-228 months). In all patients overall toleration of FSRT was very good. Acute toxicity was mild. Prior to RT, 29 patients complained about any kind of visual impairment including visual field deficits, diplopia or amaurosis. Prior surgical resection was identified as a negative prognostic factor for visual outcome, whereas patients with larger tumor volumes demonstrated a higher number of patients with improvement of pre-existing visual deficits.ConclusionLong-term outcome after FSRT for ONSM shows improved vision in patients not treated surgically prior to RT; moreover, the best improvement of visual deficits are observed in patients with larger target volumes. The absence of tumor recurrences supports that FSRT is a strong alternative to surgical resection especially in small tumors without extensive compression of normal tissue structures
Highlights
Treatment of primary optic nerve sheath meningiomas (ONSM) remains a challenge in the interdisciplinary team of surgeons, opthalmologists and radiation oncologists
Prior surgical resection was identified as a negative prognostic factor for visual outcome, whereas patients with larger tumor volumes demonstrated a higher number of patients with improvement of pre-existing visual deficits
Long-term outcome after fractionated stereotactic radiotherapy (FSRT) for ONSM shows improved vision in patients not treated surgically prior to RT; the best improvement of visual deficits are observed in patients with larger target volumes
Summary
Treatment of primary optic nerve sheath meningiomas (ONSM) remains a challenge in the interdisciplinary team of surgeons, opthalmologists and radiation oncologists. They are located directly adjacent to the optic nerve which is sensitive to any treatment damage, including radiation or surgical procedures. They arise from meningothelial cap cells of arachniod villi which surround the optical nerve within the orbit or within the intracanalicular part of the optic nerve. There have been only a few series with improved vision after surgical treatment [14,15]
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