Controversy in the management of optic nerve glioma

Abstract

The records of 16 patients with optic nerve glioma treated between 1961 and 1984 were reviewed. All patients except two had extension of tumor beyond the chiasm to the hypothalamus, adjacent brain and/or along the posterior optic tract. Eleven of 16 cases were biopsy-proven, two patients had craniotomy and visual inspection but no biopsy was performed, and in two cases the biopsy was not diagnostic. Fourteen patients received radiation therapy, usually consisting of 50 Gy in 5 weeks (range 40-56 Gy), one patient was treated surgically and one with chemotherapy. With a follow-up of 1 to 20 years, 7 of the 14 patients irradiated are alive, three patients are dead of disease at 3, 6 and 9 years post-treatment, three were lost to follow-up at 1, 8, and 8 years, and one is dead of intercurrent disease at 5.5 years. Overall vision was improved in five patients and stable in seven following treatment. In two patients, vision could not be evaluated because of young age at presentation. Four patients had recurrences. One was retreated with 30 Gy in 3 weeks and shows no evidence of disease at 20 years. The three other patients died of their disease. There is controversy over the best treatment for these patients. Based on these results and a review of the literature, the authors recommendation is to irradiate tumors with extension beyond the chiasm at the time of presentation rather than waiting for increasing symptoms because function that is lost may not always be recovered. Chemotherapy needs to be further investigated but holds promise, especially for the younger children.

Isolated low grade pilocytic astrocytoma of the optic nerve in the elderly: case report

“…Radiotherapy (RT) and radiosurgery might be more effective in posterior tumors than surgery alone in preventing relapse, but their morbidity should be taken into consideration. RT alone or after partial resection shows relapse-free rates of 56-90% (2) . Long-term prognosis, however, apparently does not change after any adjuvant treatment (3) .…”

“…They occur most frequently in children and young adults, 75% of them in the first decade and 90% in the first two decades of life (1)(2)(3) . They may be confined to the optic disc and nerve (25%) or may involve the chiasma with or without the optic nerves in 20-40% of cases (1)(2) .…”

Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain

“…Failures occurred more rapidly after the second treatment. In the report of Weiss et al [76], one patient was reirradiated 8 years after primary treatment because of recurrent disease at a dose prescription of 30 Gy given in 3 weeks. He was reported to remain alive and well at 20 years with stable, although poor vision.…”

Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain

“…The risk of neurocognitive dysfunction and changes in behavior is an important issue in the management of low-grade glioma, as quality of life may be severely compromised [10,17,72]. Pollack et al [54] reported on complications and treatment-related sequelae presumably related to surgery followed by radiotherapy in glioma of the hemispheres.…”

“…Danoff et al [17] reported on four of 15 living patients with mental retardation, two of whom were in semicomatose state after radiation therapy. Weiss et al [72] noted five of 16 patients with mental retardation after radiation, although one had meningitis as a possible causative factor. Deficits before radiotherapy are not unusual.…”