Stereotactic Radiosurgery for Perioptic Meningiomas: An International, Multicenter Study.

Abstract

Stereotactic radiosurgery (SRS) is increasingly used for management of perioptic meningiomas. To study the safety and effectiveness of SRS for perioptic meningiomas. From 12 institutions participating in the International Radiosurgery Research Foundation (IRRF), we retrospectively assessed treatment parameters and outcomes following SRS for meningiomas located within 3 mm of the optic apparatus. A total of 438 patients (median age 51 yr) underwent SRS for histologically confirmed (29%) or radiologically suspected (71%) perioptic meningiomas. Median treatment volume was 8.01 cm3. Median prescription dose was 12 Gy, and median dose to the optic apparatus was 8.50Gy. A total of 405 patients (93%) underwent single-fraction SRS and 33 patients (7%) underwent hypofractionated SRS. During median imaging follow-up of 55.6 mo (range: 3.15-239 mo), 33 (8%) patients experienced tumor progression. Actuarial 5-yr and 10-yr progression-free survival was 96% and 89%, respectively. Prescription dose of ≥12 Gy (HR: 0.310; 95% CI [0.141-0.679], P=.003) and single-fraction SRS (HR: 0.078; 95% CI [0.016-0.395], P=.002) were associated with improved tumor control. A total of 31 (10%) patients experienced visual decline, with actuarial 5-yr and 10-yr post-SRS visual decline rates of 9% and 21%, respectively. Maximum dose to the optic apparatus ≥10Gy (HR=2.370; 95% CI [1.086-5.172], P=.03) and tumor progression (HR=4.340; 95% CI [2.070-9.097], P<.001) were independent predictors of post-SRS visual decline. SRS provides durable tumor control and quite acceptable rates of vision preservation in perioptic meningiomas. Margin dose of ≥12Gy is associated with improved tumor control, while a dose to the optic apparatus of ≥10Gy and tumor progression are associated with post-SRS visual decline.