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Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study
DT. Asuzu, A. Bunevicius, R. Kormath Anand, M. Suleiman, AM. Nabeel, WA. Reda, SR. Tawadros, K. Abdel Karim, AMN. El-Shehaby, RM. Emad Eldin, T. Chytka, R. Liščák, K. Sheehan, D. Sheehan, M. Perez Caceres, D. Mathieu, CC. Lee, HC. Yang, P....
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Humans MeSH
- Meningeal Neoplasms * diagnostic imaging radiotherapy surgery MeSH
- Meningioma * diagnostic imaging radiotherapy surgery MeSH
- Follow-Up Studies MeSH
- Radiosurgery * adverse effects methods MeSH
- Retrospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
OBJECTIVE: Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus. METHODS: The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression. RESULTS: SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9-1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0-1.02, adjusted p = 0.02). CONCLUSIONS: In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.
Centro Gamma Knife Dominicano and CEDIMAT Radiology Department Santo Domingo Dominican Republic
Clinical Oncology Department Ain Shams University Cairo Egypt
Department of Neurosurgery Humanitas Clinical and Research Center IRCCS Rozzano Italy
Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital Taipei Taiwan
Department of Neurosurgery University of Southern California Los Angeles California
Department of Neurosurgery University of Virginia Charlottesville Virginia
Department of Neurosurgery West Virginia University Morgantown West Virginia
Department of Radiation Oncology University of Colorado Aurora Colorado
Department of Radiation Oncology University of Southern California Los Angeles California
Department of Radiation Oncology West Virginia University Morgantown West Virginia
Division of Radiation Oncology Department of Oncology University of Alberta Edmonton Canada
Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt
Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati Ohio
Neurosurgery Department Ain Shams University Cairo Egypt
Neurosurgery Department Benha University Qalubya Egypt
Radiation Oncology Department National Cancer Institute Cairo University Egypt
School of Medicine National Yang Ming University Taipei Taiwan
Stereotactic and Radiation Neurosurgery Department Na Homolce Hospital Prague Czech Republic
References provided by Crossref.org
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- $a OBJECTIVE: Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus. METHODS: The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression. RESULTS: SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9-1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0-1.02, adjusted p = 0.02). CONCLUSIONS: In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.
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