Stereotactic Radiosurgery for Perioptic Meningiomas: An International, Multicenter Study

Abstract

BACKGROUND Stereotactic radiosurgery (SRS) is increasingly used for management of perioptic meningiomas. OBJECTIVE To study the safety and effectiveness of SRS for perioptic meningiomas. METHODS 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. RESULTS 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 8.50 Gy. 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 ≥10 Gy (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. CONCLUSION SRS provides durable tumor control and quite acceptable rates of vision preservation in perioptic meningiomas. Margin dose of ≥12 Gy is associated with improved tumor control, while a dose to the optic apparatus of ≥10 Gy and tumor progression are associated with post-SRS visual decline.

Hypofractionated Radiosurgery for Large or in Critical-Site Intracranial Meningioma: Results of a Phase 2 Prospective Study

“…Although optic nerves, chiasm and optic tracts, as well as all sensory cranial nerves, are the most sensitive neural structures, RION is reported as being a rare complication. 6,[14][15][16]20 Mayo C et al 29 found that the incidence of RION was negligible for doses below 10-12 Gy in RS. Nevertheless, limited data exist about tolerance doses for fractionated high-dose treatments like hypo-RS.…”

“…Owing to these features, RS could prove to be an effective and safe treatment for meningioma due to its inherent ability to deliver a sharply focused highdose radiation to a solitary target, while sparing normal surrounding tissues. 6,19,20 Literature data on RS show tumor control rate at 10 years ranging from 71% to 97.2% 5 and an improvement of pre-existing cranial nerve deficits in 70% to 100% of patients with small to medium-size lesions. However, for relatively large-sized lesions or for those in close relation to cranial nerves and vascular structures, 21 RS provided lower results, both in primary and adjuvant setting.…”

Combined helical tomotherapy and Gamma Knife stereotactic radiosurgery for high-grade recurrent orbital meningioma: a case report

“…Some studies suggest using higher margin doses (> 13 Gy) to achieve better local control ( 34 ). For patients receiving SRS, a single dose of 14-18 Gy is typically used at most radiation centers for similar local control, while doses ≤ 12 Gy are associated with poorer local control rates ( 35 ), and doses ≥ 10 Gy to the optic apparatus are associated with decreased vision after SRS ( 36 ). Low fractionated treatment for meningiomas around the optic nerve can deliver SRS doses of 19.5 Gy/3 fractions and 25 Gy/5 fractions to the optic pathway while still maintaining a lower risk of optic neuropathy and the typical range for radiation therapy margin doses in WHO grade 3 meningiomas are 18 to 24 Gy ( 37 ).…”

Tumors Involving the Infratemporal Fossa: A Systematic Review of Clinical Characteristics and Treatment Outcomes

“…While chemotherapy has been documented to improve survival in malignant lesions, radiotherapy as a primary or adjuvant modality aims mainly to halt tumor progression. Studies that investigated the efficacy of radiotherapy for meningiomas and schwannomas reported high 10-year PFS rates of up to 90–98% [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. However, since different tumor types respond differently to various modalities, it is essential to tailor a personalized management plan based on the patient tumor pathology and their clinical condition.…”