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Title: Visual Outcome in Meningiomas Around Anterior Visual Pathways Treated With Linear Accelerator Fractionated Stereotactic Radiotherapy

Abstract

Purpose: Meningiomas threatening the anterior visual pathways (AVPs) and not amenable for surgery are currently treated with multisession stereotactic radiotherapy. Stereotactic radiotherapy is available with a number of devices. The most ubiquitous include the gamma knife, CyberKnife, tomotherapy, and isocentric linear accelerator systems. The purpose of our study was to describe a case series of AVP meningiomas treated with linear accelerator fractionated stereotactic radiotherapy (FSRT) using the multiple, noncoplanar, dynamic conformal rotation paradigm and to compare the success and complication rates with those reported for other techniques. Patients and Methods: We included all patients with AVP meningiomas followed up at our neuro-ophthalmology unit for a minimum of 12 months after FSRT. We compared the details of the neuro-ophthalmologic examinations and tumor size before and after FSRT and at the end of follow-up. Results: Of 87 patients with AVP meningiomas, 17 had been referred for FSRT. Of the 17 patients, 16 completed >12 months of follow-up (mean 39). Of the 16 patients, 11 had undergone surgery before FSRT and 5 had undergone FSRT as first-line management. Tumor control was achieved in 14 of the 16 patients, with three meningiomas shrinking in size after RT. Two meningiomas progressed, one in an areamore » that was outside the radiation field. The visual function had improved in 6 or stabilized in 8 of the 16 patients (88%) and worsened in 2 (12%). Conclusions: Linear accelerator fractionated RT using the multiple noncoplanar dynamic rotation conformal paradigm can be offered to patients with meningiomas that threaten the anterior visual pathways as an adjunct to surgery or as first-line treatment, with results comparable to those reported for other stereotactic RT techniques.« less

Authors:
 [1];  [2];  [3];  [2];  [3];  [3];  [2];  [3];  [2];  [2];  [3];  [2];  [3];  [2];  [2]
  1. Neuro-Ophthalmology Unit, Rabin Medical Center, Petah Tikva (Israel)
  2. (Israel)
  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel)
Publication Date:
OSTI Identifier:
22056032
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 82; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPUTERIZED TOMOGRAPHY; CT-GUIDED RADIOTHERAPY; FRACTIONATION; LINEAR ACCELERATORS; NEOPLASMS; OPHTHALMOLOGY; PATIENTS; SURGERY

Citation Formats

Stiebel-Kalish, Hadas, E-mail: kalishhadas@gmail.com, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Reich, Ehud, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Gal, Lior, Rappaport, Zvi Harry, Department of Neurosurgery, Rabin Medical Center, Petah Tikva, Nissim, Ouzi, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Pfeffer, Raphael, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, Spiegelmann, Roberto, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, and Department of Neurosurgery, Sheba Medical Center, Ramat Gan. Visual Outcome in Meningiomas Around Anterior Visual Pathways Treated With Linear Accelerator Fractionated Stereotactic Radiotherapy. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2010.12.017.
Stiebel-Kalish, Hadas, E-mail: kalishhadas@gmail.com, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Reich, Ehud, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Gal, Lior, Rappaport, Zvi Harry, Department of Neurosurgery, Rabin Medical Center, Petah Tikva, Nissim, Ouzi, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Pfeffer, Raphael, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, Spiegelmann, Roberto, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, & Department of Neurosurgery, Sheba Medical Center, Ramat Gan. Visual Outcome in Meningiomas Around Anterior Visual Pathways Treated With Linear Accelerator Fractionated Stereotactic Radiotherapy. United States. doi:10.1016/J.IJROBP.2010.12.017.
Stiebel-Kalish, Hadas, E-mail: kalishhadas@gmail.com, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Reich, Ehud, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Gal, Lior, Rappaport, Zvi Harry, Department of Neurosurgery, Rabin Medical Center, Petah Tikva, Nissim, Ouzi, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Pfeffer, Raphael, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, Spiegelmann, Roberto, Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan, and Department of Neurosurgery, Sheba Medical Center, Ramat Gan. 2012. "Visual Outcome in Meningiomas Around Anterior Visual Pathways Treated With Linear Accelerator Fractionated Stereotactic Radiotherapy". United States. doi:10.1016/J.IJROBP.2010.12.017.
@article{osti_22056032,
title = {Visual Outcome in Meningiomas Around Anterior Visual Pathways Treated With Linear Accelerator Fractionated Stereotactic Radiotherapy},
author = {Stiebel-Kalish, Hadas, E-mail: kalishhadas@gmail.com and Sackler School of Medicine, Tel Aviv University, Tel Aviv and Reich, Ehud and Department of Ophthalmology, Rabin Medical Center, Petah Tikva and Gal, Lior and Rappaport, Zvi Harry and Department of Neurosurgery, Rabin Medical Center, Petah Tikva and Nissim, Ouzi and Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan and Department of Neurosurgery, Sheba Medical Center, Ramat Gan and Pfeffer, Raphael and Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan and Spiegelmann, Roberto and Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan and Department of Neurosurgery, Sheba Medical Center, Ramat Gan},
abstractNote = {Purpose: Meningiomas threatening the anterior visual pathways (AVPs) and not amenable for surgery are currently treated with multisession stereotactic radiotherapy. Stereotactic radiotherapy is available with a number of devices. The most ubiquitous include the gamma knife, CyberKnife, tomotherapy, and isocentric linear accelerator systems. The purpose of our study was to describe a case series of AVP meningiomas treated with linear accelerator fractionated stereotactic radiotherapy (FSRT) using the multiple, noncoplanar, dynamic conformal rotation paradigm and to compare the success and complication rates with those reported for other techniques. Patients and Methods: We included all patients with AVP meningiomas followed up at our neuro-ophthalmology unit for a minimum of 12 months after FSRT. We compared the details of the neuro-ophthalmologic examinations and tumor size before and after FSRT and at the end of follow-up. Results: Of 87 patients with AVP meningiomas, 17 had been referred for FSRT. Of the 17 patients, 16 completed >12 months of follow-up (mean 39). Of the 16 patients, 11 had undergone surgery before FSRT and 5 had undergone FSRT as first-line management. Tumor control was achieved in 14 of the 16 patients, with three meningiomas shrinking in size after RT. Two meningiomas progressed, one in an area that was outside the radiation field. The visual function had improved in 6 or stabilized in 8 of the 16 patients (88%) and worsened in 2 (12%). Conclusions: Linear accelerator fractionated RT using the multiple noncoplanar dynamic rotation conformal paradigm can be offered to patients with meningiomas that threaten the anterior visual pathways as an adjunct to surgery or as first-line treatment, with results comparable to those reported for other stereotactic RT techniques.},
doi = {10.1016/J.IJROBP.2010.12.017},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 82,
place = {United States},
year = 2012,
month = 2
}
  • Purpose: To evaluate the role of {sup 11}C-methionine positron emission tomography (MET-PET) in target volume delineation for meningiomas and to determine the interobserver variability. Methods and Materials: Two independent observers performed treatment planning in 10 patients according to a prospective written protocol. In the first step, they used coregistered computed tomography (CT) and magnetic resonance imaging (MRI). In the second step, MET-PET was added to CT/MRI (image fusion based on mutual information). Results: The correlation between gross tumor volume (GTVs) delineated by the two observers based on CT/MRI was r = 0.855 (Spearman's correlation coefficient, p = 0.002) and rmore » = 0.988 (p = 0.000) when MET-PET/CT/MRI were used. The number of patients with agreement in more then 80% of the outlined volume increased with the availability of MET-PET from 1 in 10 to 5 in 10. The median volume of intersection between the regions delineated by two observers increased significantly from 69% (from the composite volume) to 79%, by the addition of MET-PET (p = 0.005). The information of MET-PET was useful to delineate GTV in the area of cavernous sinus, orbit, and base of the skull. Conclusions: The hypothesis-generating findings of potential normal tissue sparing and reduced interobserver variability provide arguments for invasive studies of the correlation between MET-PET images and histologic tumor extension and for prospective trials of target volume delineation with CT/MRI/MET-PET image fusion.« less
  • Purpose: To evaluate long-term outcome of cavernous sinus meningioma (CSM) treated with fractionated conformal radiotherapy (FCR). Patients and Methods: Fifty-three patients with CSMs (16 men [30.2%], 37 women [69.8%], aged 53 {+-} 13.0 years [mean {+-} SD]) were treated by FCR. In 28 patients (52.8%) FCR was performed as first-line treatment and in 25 patients (47.2%) as adjuvant treatment. All patients received FCR with a dose of 52.9 {+-} 1.8 Gy in 29.4 {+-} 1.0 fractions over 6 weeks. Dose per fraction was 1.9 {+-} 0.1 Gy. Radiotherapy was delivered stereotactically in 47 cases (88.7%) and conformally in 6 (11.3%)more » Results: The median follow-up was 6.9 years (range, 3-19 years). According to Sekhar's classification, 19 patients (35.8%) were Grade 1-2, 30 patients (56.6%) were Grade 3-4, and 4 patients (7.6%) were Grade 5. Pretreatment tumor volume was determined in 46 patients, and tumor volume was 12.6 {+-} 8.2 cm{sup 3}. In these patients, the distance between tumor and optic apparatus was 1.62 {+-} 1.2 mm. Actuarial 5- and 10-year progression-free survival rates were 98.1% and 95.8%, respectively. Clinical improvement was observed in 31 patients (58.5%), and 20 patients (37.7%) remained unchanged. Radiologic response was observed in 18 patients (30.2%), and 35 patients (66.0%) showed stable lesions. Two patients (3.8%) showed tumor progression during follow-up. Transient morbidity was observed in 3 patients (5.7%) and permanent morbidity in 1 (1.9%). Conclusion: Fractionated conformal radiotherapy affords satisfactory long-term tumor control and low treatment morbidity.« less
  • Purpose: To provide the long-term outcomes of patients treated with fractionated conformal radiotherapy (FCRT) for presumed optic nerve sheath meningiomas (ONSMs). Patients and Methods: Between 1995 and 2002, 9 patients with a presumed ONSM were treated with FCRT at our institution. The indications for FCRT were significant visual dysfunction at presentation, progression of visual dysfunction during a period of observation, tumor growth documented by sequential imaging, or a combination of these findings. In 2 patients, FCRT was performed as adjuvant therapy, and in 7, it was the initial and primary treatment. Results: Of the 9 patients, 6 were women andmore » 3 were men, with a mean age of 47 years. All 9 patients had evidence of optic nerve dysfunction in the affected eye, characterized by reduced visual acuity, a visual field defect, and a relative afferent pupillary defect. In addition, 2 patients had proptosis and 1 had diplopia. The mean follow-up period was 98 {+-} 31.7 months (median, 90; range, 61-151). After FCRT, the visual function improved in the 7 patients who had undergone FCRT as the primary treatment. However, 2 patients who were blind in their affected eye at FCRT remained blind. In 4 of the 7 patients with improvement, the improvement was documented within 1-3 months after FCRT. The tumor control rate was 100%. Proptosis and diplopia also regressed in 100% of patients. At 2 years after FCRT, 1 patient had developed radiation retinopathy. Conclusion: The results of our study have shown that FCRT is a safe and effective treatment of ONSMs, affording satisfactory long-term tumor control, good functional outcome, and low treatment morbidity. FCRT should be considered the treatment of choice for patients with presumed ONSMs for whom the treatment has been deemed appropriate.« less
  • Purpose: To evaluate the influence of {sup 68}-Ga-labeled DOTA ( )-D-Phe ({sup 1})-Tyr ({sup 3})-Octreotide positron emission tomography ([{sup 68}Ga]-DOTATOC-PET) for target definition for fractionated stereotactic radiotherapy (FSRT) as a complementary modality to computed tomography (CT) and magnetic resonance imaging (MRI). Because meningiomas show a high expression of somatostatin receptor subtype 2, somatostatin analogs such as DOTATOC offer the possibility of receptor-targeted imaging. Patients and Methods: Twenty-six patients received stereotactic CT, MRI, and [{sup 68}Ga]-DOTATOC-PET as part of their treatment planning. Histology was: World Health Organization (WHO) Grade 1 61.5%, WHO Grade 2 7.7%, WHO Grade 3 3.9%, and undeterminedmore » 26.9%. Six patients received radiotherapy as primary treatment, 2 after subtotal resection; 17 patients were treated for recurrent disease. Dynamic PET scans were acquired before radiotherapy over 60 min after intravenous injection of 156 {+-} 29 MBq [{sup 68}Ga]-DOTATOC. These PET images were imported in the planning software for FSRT. Planning target volume (PTV)-I outlined on CT and contrast-enhanced MRI was compared with PTV-II outlined on PET. PTV-III was defined with CT, MRI, and PET and was actually used for radiotherapy treatment. Results: PTV-III was smaller than PTV-I in 9 patients, the same size in 7 patients, and larger in 10 patients. Median PTV-I was 49.6 cc, median PTV-III was 57.2 cc. In all patients [{sup 68}Ga]-DOTATOC-PET delivered additional information concerning tumor extension. PTV-III was significantly modified based on DOTATOC-PET data in 19 patients. In 1 patient no tumor was exactly identified on CT/MRI but was visible on PET. Conclusion: These data demonstrate that [{sup 68}Ga]-DOTATOC-PET improves target definition for FSRT in patients with intracranial meningiomas. Radiation targeting with fused DOTATOC-PET, CT, and MRI resulted in significant alterations in target definition in 73%.« less
  • Purpose: To assess the use of stereotactic fractionated radiotherapy (SRT) for the treatment of meningiomas. Methods and Materials: Between April 1999 and October 2004, 38 patients underwent SRT. Of 34 patients (36 tumors) assessed, the median age was 53 years. The indication was primary treatment in 26 cases (no histology) and postoperative in 10 cases. The most common sites were cavernous sinus (17), optic nerve (6), and cerebellopontine angle (5). The median gross target volume and planning target volume were 8.9 cm{sup 3} and 18.9 cm{sup 3}, respectively. Stereotactic treatment was delivered with 6-MV photons with static conformal fields (custom-mademore » blocks, 9 patients, and micromultileaf collimator, 25 patients). Median number of fields was six. The median dose prescribed was 50 Gy (range, 45-50.4 Gy) in 28 fractions. The median homogeneity and conformality indices were 1.1 and 1.79, respectively. Results: Treatment was well tolerated. Median follow-up was 26 months with 100% progression-free survival. One patient developed an area of possible radionecrosis related to previous radiotherapy, and 2 men developed mild hypogonadism necessitating testosterone replacement. The vision of 5 of 6 patients with optic pathway meningiomas improved or remained static. Conclusions: Stereotactic fractionated radiotherapy for the treatment of meningiomas is practical, and with early follow-up, seems to be effective.« less