Long-term efficacy of fractionated conformal radiotherapy for the management of primary optic nerve sheath meningioma. Issue 10 (20th December 2018)

• Record Type: Journal Article
• Authors: Pandit, Ravi; Paris, Liliana; Rudich, Danielle S; Lesser, Robert L; Kupersmith, Mark J; Miller, Neil R
• Is Part Of: British journal of ophthalmology. Volume 103:Issue 10(2019)
• Page Start: 1436
• Page End: 1440
• Publication Date: 2018-12-20
• Subjects: optic nerve -- colour vision -- field of vision -- orbit -- visual pathway; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2018-313135
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background/Aim: Fractionated conformal radiotherapy (FCRT) is now used to treat vision-threatening optic nerve sheath meningioma (ONSM), but long-term efficacy and safety data are lacking; the purpose of this study was to assess these key data. Methods: This is a retrospective chart review with prospective follow-up of adult patients treated with FCRT for primary ONSM at four academic medical centres between 1995 and 2007 with ≥10 years of follow-up after treatment. Results: 16 patients were identified with a mean post-treatment follow-up of 14.6 years (range: 10.5–20.7 years). The mean age at symptom onset was 47.6 years (range: 36–60 years). FCRT was performed at a mean of 2.3 years after symptom onset (range: 0.2–14.0 years). At last follow-up, visual acuity had improved or stabilised in 14 of the 16 (88%) patients, and 11 (69%) had retained or achieved ≥20/40. The mean deviation on automated perimetry remained stable (−14.5 dB pretreatment vs −12.2 dB at last follow-up; p=0.68, n=10). Two (11%) patients had persistent pain, proptosis or diplopia, compared with six (38%) pretreatment (p=0.11). Two (13%) patients developed radiation retinopathy more than 6 months after completion of therapy, one (50%) of whom had worse visual acuity compared with pretreatment. No patient developed tumour involvement or radiation damage in the fellow eye. Conclusion: FCRT stabilises or improves visual function in patients with primary ONSM and is associated with a low risk of significant ocular sequelae. This treatment should be considered instead of surgery in patients with primary ONSM who require intervention due to loss of visual sensory and/or ocular motor function.