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.

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 Milan Italy

Department of Neurosurgery Neurological Institute Taipei Veteran General Hospital Taipei Taiwan

Department of Neurosurgery Université de Sherbrooke Centre de recherche du CHUS Sherbrooke Québec Canada

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 Denver 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 Giza Egypt

School of Medicine National Yang Ming University Taipei Taiwan

Stereotactic and Radiation Neurosurgery Department Na Homolce Hospital Prague Czech Republic

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