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Torres-Ríos JA, Rodríguez-Camacho A, Basilio-Tomé E, Meraz-Soto JM, Camacho-Ordonez A, Romero-Luna G, Gutierrez-Aceves GA, Olhovich IG, Celis-López MA, Hernández-Sánchez LC, Moreno-Jiménez S. Radiation therapy for optic nerve sheath meningiomas: Local control and treatment related visual changes. World Neurosurg X 2024; 23:100291. [PMID: 38523881 PMCID: PMC10958468 DOI: 10.1016/j.wnsx.2024.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Objective Our primary objective is to evaluate the local control of optic nerve sheath meningiomas (ONSMs) treated with ionizing radiation and related visual changes after treatment. Our secondary objective is to describe the clinical characteristics and perform an analysis of the treatment impact on the functional status of this group of patients. Methods We present our series of 19 patients treated with ionizing radiation therapy at our radio-neurosurgery unit between 2016 and 2022. The setting, ophthalmological follow-up, morbidity, and survival are analyzed and discussed. Results Patients were followed up, and the impact of treatment on local disease control, visual alterations of the affected eye, and functional status of the patient were analyzed. The progression-free survival (PFS) median was 60 months (95% CI 50.3-69.6 months). The estimated PFS rates at 48 and 66 months were 100% and 66%, respectively. At diagnosis, nine (47.3%) eyes were in amaurosis and ten (52.6%) with vision. Of the ten patients without amaurosis at the time of diagnosis, three (30%) maintained unchanged visual acuity, and seven (70%) had decreased visual acuity; three of them developed amaurosis during the first year after treatment (p = 0.018). Conclusions Using ionizing radiation therapy is a successful treatment for the local control of ONSMs. This therapeutic modality can compromise the visual acuity of the affected eye and improve dyschromatopsia and campimetry defects. The life prognosis is good for these patients, with a zero mortality rate, but their vision prognosis is poor.
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Affiliation(s)
- Jorge Alejandro Torres-Ríos
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Alejandro Rodríguez-Camacho
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Radiotherapy Department of Oncology Hospital, XXI Century Mexican Institute of Social Security, Mexico City, Mexico
| | - Estefania Basilio-Tomé
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Juan Marcos Meraz-Soto
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Azyadeh Camacho-Ordonez
- Neuro-Ophthalmology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Gerardo Romero-Luna
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Guillermo Axayacatl Gutierrez-Aceves
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Irene González Olhovich
- Neuro-Ophthalmology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | - Miguel Angel Celis-López
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
| | | | - Sergio Moreno-Jiménez
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- Neurosurgery Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, 14269, Mexico
- American British Cowdray Medical Center, Cancer Center, Mexico City, 01120, Mexico
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Koç İ, Yüce Sarı S, Yazıcı G, Kapucu Y, Kıratlı H, Zorlu F. Role of hypofractionated stereotactic radiotherapy for primary optic nerve sheath meningioma. Neurooncol Pract 2024; 11:150-156. [PMID: 38496921 PMCID: PMC10940822 DOI: 10.1093/nop/npad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Optic nerve sheath meningiomas (ONSM) are rare tumors potentially causing visual deficits. This study aims to report the anatomic and visual outcomes of patients with primary ONSM treated with hypofractionated stereotactic radiotherapy (HF-SRT). Methods Data of 36 patients treated with HF-SRT between 2008 and 2019 were retrospectively collected. The clinical target volume (CTV) was equal to the gross tumor volume and a 2 mm was added for the planning target volume. All responses other than progression were accepted as local control (LC). The VA grading was performed under 3 groups to provide an even distribution; 20/400 or worse, 20/40-20/400, and 20/40 or better. Results Median HF-SRT dose was 25 Gy and the median CTV was 1.94 cc. After a median of 106 months of follow-up, the tumor regressed in 23 (64%), was stable in 9 (25%), and progressed in 4 (11%) eyes. The overall rate of LC was 89% with 2-, 5-, 10-, and 15-year rate of 100%, 94%, 84%, and 84%, respectively. Treatment-related late toxicity rate was 11%. The VA was stable in 27 (75%) eyes, improved in 5 (14%) eyes, and worsened in 4 (11%) eyes, respectively, after HF-SRT. Female gender was the only independent predictor of an improved VA. Conclusions Hypofractionated stereotactic radiotherapy is a safe and satisfactory treatment option for primary ONSM without severe toxicity. It may be advisable to commence treatment before an established visual deficit of 20/400 or worse occurs, to make the most of the functional benefit.
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Affiliation(s)
- İrem Koç
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sezin Yüce Sarı
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gözde Yazıcı
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yasemin Kapucu
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hayyam Kıratlı
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Faruk Zorlu
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
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Bin Sumaida A, Shanbhag NM, Balaraj K. Evaluating the Efficacy and Safety of CyberKnife for Meningiomas: A Systematic Review. Cureus 2024; 16:e56848. [PMID: 38528994 PMCID: PMC10961244 DOI: 10.7759/cureus.56848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 03/27/2024] Open
Abstract
This systematic review aims to evaluate CyberKnife (Accuray, Madison, WI, USA) radiosurgery's efficacy, safety, and outcomes in treating meningiomas, focusing on tumour control rates, symptom relief, survival rates, quality of life, and adverse events. A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), covering studies published in the last 20 years and available in English. The inclusion criteria targeted studies involving patients with meningioma treated with CyberKnife radiosurgery, reporting on specific outcomes of interest. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies, and a narrative synthesis approach was adopted for data analysis. Twenty-one studies met the inclusion criteria, encompassing various design types and patient demographics. The review highlights CyberKnife's effectiveness in managing benign and atypical meningiomas and specific challenging cases like perioptic lesions and large cranial base tumours. Key findings include high tumour control rates, preservation or improvement of visual functions in perioptic lesions, and promising results in benign spinal tumours and supratentorial meningiomas. Comparative analyses suggest better radiographic tumour control and a lower incidence of post-treatment complications with stereotactic radiotherapy over stereotactic radiosurgery. Long-term outcomes and safety profiles underline the viability of CyberKnife as a treatment option, with minimal permanent side effects reported. CyberKnife radiosurgery is a highly effective and safe treatment modality for meningiomas. It offers significant benefits in tumour control, symptom relief, and maintaining the quality of life with minimal adverse effects. The precision and adaptability of CyberKnife technology make it a valuable addition to the treatment arsenal for meningiomas. It necessitates further research and adoption in clinical practice, especially in regions like the United Arab Emirates, where its use is emerging.
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Affiliation(s)
| | - Nandan M Shanbhag
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
- Oncology/Radiation Oncology/Palliative Care, Tawam Hospital, Al Ain, ARE
| | - Khalid Balaraj
- Oncology/Radiation Oncology, Tawam Hospital, Al Ain, ARE
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Tang T, Wang J, Lin T, Zhai Z, Song X. The treatment efficacy of radiotherapy for optic nerve sheath meningioma. Eye (Lond) 2024; 38:89-94. [PMID: 37349547 PMCID: PMC10764342 DOI: 10.1038/s41433-023-02640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES Optic nerve sheath meningioma (ONSM) is a rare benign tumour that accounts for approximately 2% of all orbital tumours. Radiotherapy has gradually become an important treatment for ONSM because of its good effect in preserving or improving vision. We aimed to explore the effect of radiotherapy on tumour control and vision preservation/improvement in patients with ONSM. METHODS Forty-three patients with primary ONSM treated in our institution from 2015 to 2021 were enrolled. The irradiation dose was from 50.4 to 54 Gy with 28-30 fractions. We evaluated the tumour volume on MRI or CT, and visual acuity before and after the radiotherapy. RESULTS Thirty-four patients (79%) experienced a vision decrease at diagnosis. The mean duration of follow-up was 54.1 months (ranges: 18-93, median: 56). Among 25 patients who had tumour evaluation using MRI, 16 patients (37.2%) showed stable tumours, 7 patients (16.3%) had tumour shrinkage, but 2 patients (4.7%) experienced tumour progression. Among the 39 patients performing vision acuity evaluation, 16 patients (37.2%) had vision improvement or recovery. 16 of the 23 patients without vision improvement demonstrated severe visual loss at diagnosis. Two patients had evidence of tumour progression during the follow-up. Additionally, 4 (10.2%) patients had dry eyes, 7 (17.9%) patients experienced watery eyes, and 3 (7.7%) patients had eye swelling. Patients with vision loss for more than 12 months had a lower possibility of vision recovery than those with vision loss for less than 12 months. CONCLUSIONS Radiotherapy such as IMRT, VMAT, and 3D-CRT plays an important role in the treatment of ONSM. The probability of vision recovery is lower in patients with severe vision loss at diagnosis or the duration of vision loss is more than 12 months.
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Affiliation(s)
- Tianci Tang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jie Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Tong Lin
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Zhoushijia Zhai
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Xinmao Song
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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Vaishnav YJ, Singh R, Didwania P, Lehrer EJ, Bakaeva T, Harris TJ, Migliori ME, Sheehan JP, Trifiletti DM. Radiotherapy and Radiosurgery in the Management of Optic Nerve Sheath Meningiomas: An International Systematic Review and Meta-Analysis of Twenty Studies. World Neurosurg 2022; 164:e929-e944. [PMID: 35609728 DOI: 10.1016/j.wneu.2022.05.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Optic nerve sheath meningiomas (ONMs) are often managed with radiotherapy (RT) with the goal of achieving radiographic local control (LC) and preventing deterioration of visual acuity (VA). We aimed to perform a systematic review and meta-analysis of outcomes for patients with ONM treated with RT. METHODS The PICOS/PRISMA/MOOSE selection criteria were used to identify studies. Primary outcomes were stable or improved VA and radiographic LC at last follow-up. The secondary outcomes were incidences of radiation-induced retinopathy and xerophthalmia and stable or improved visual fields (VFs). Weighted random-effects meta-analyses using the DerSimonian and Laird methods were conducted to characterize effect sizes. Mixed-effects regression models were used to examine potential correlations between gross tumor volume (GTV) and outcomes. RESULTS In total, 444 patients with ONM across 20 published studies were included. The estimated LC rate was 99.8% (95% confidence interval [CI], 98.3%-100%), and the estimated proportion of patients with stable or improved VA or VF was 89.7% (95% CI, 86.2%-92.4%) and 93.3% (95% CI, 89.5%-95.8%), respectively. Estimated incidences of radiation-induced retinopathy and xerophthalmia were 7.2% and 10.1%, respectively. GTV was significantly associated with VA (P = 0.014) with estimated VA rates of 96.4%, 91.4%, and 80.5% for GTVs of 2.0, 3.0, and 4.0 cm3, respectively. CONCLUSIONS RT was well tolerated, with excellent LC achieved. Nearly 90% of patients noted either stability or improvement in VA and VF. Larger ONMs were associated with poorer VA.
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Affiliation(s)
- Yash J Vaishnav
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Prabhanjan Didwania
- Rady School of Management, University of California San Diego, San Diego, California, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tatiana Bakaeva
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Timothy J Harris
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Michael E Migliori
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
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Masalha W, Heiland DH, Steiert C, Krüger MT, Schnell D, Heiland P, Bissolo M, Grosu AL, Schnell O, Beck J, Grauvogel J. Management of Medial Sphenoid Wing Meningioma Involving the Cavernous Sinus: A Single-Center Series of 105 Cases. Cancers (Basel) 2022; 14:2201. [PMID: 35565330 PMCID: PMC9102569 DOI: 10.3390/cancers14092201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Medial sphenoid wing meningiomas are among the three most common intracranial meningiomas. These tumors pose a challenge to neurosurgeons in terms of surgical treatment, as they may involve critical neurovascular structures and invade the cavernous sinus. In case of the latter, a complete resection may not be achievable. The purpose of this study was to investigate prognostic features affecting recurrence and progression-free survival (PFS) of medial sphenoid wing meningiomas involving the cavernous sinus, focusing on the contribution of surgery and postoperative radiotherapy. METHODS A retrospective analysis was conducted of the database of our institution, and 105 cases of medial sphenoid wing meningioma with invasion of the cavernous sinus, which were treated between 1998 and 2019, were included. Surgical treatment only was performed in 64 cases, and surgical treatment plus postoperative radiotherapy was performed in 41 cases. Kaplan-Meier analysis was conducted to estimate median survival and PFS rates, and Cox regression analysis was applied to determine significant factors that were associated with each therapeutic modality. RESULTS The risk of recurrence was significantly reduced after near-total resection (NTR) (p-value = 0.0011) compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy (p-value = 0.0002). CONCLUSIONS Maximal safe resection and postoperative stereotactic radiotherapy significantly reduced the recurrence rate of medial sphenoid wing meningiomas with infiltration of the cavernous sinus.
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Affiliation(s)
- Waseem Masalha
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Christine Steiert
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Marie T. Krüger
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
- Department of Neurosurgery, Cantonal Hospital St. Gallen, 9000 St. Gallen, Switzerland
| | - Daniel Schnell
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
- Department of Radiation Oncology, Medical Centre—University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Pamela Heiland
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Marco Bissolo
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Anca-L. Grosu
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
- Department of Radiation Oncology, Medical Centre—University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Jürgen Beck
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Centre—University of Freiburg, 79106 Freiburg, Germany; (D.H.H.); (C.S.); (M.T.K.); (P.H.); (M.B.); (O.S.); (J.B.); (J.G.)
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (D.S.); (A.-L.G.)
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68Ga-DOTATOC-PET/MRI-A Secure One-Stop Shop Imaging Tool for Robotic Radiosurgery Treatment Planning in Patients with Optic Nerve Sheath Meningioma. Cancers (Basel) 2021; 13:cancers13133305. [PMID: 34282752 PMCID: PMC8267930 DOI: 10.3390/cancers13133305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Optic nerve sheath meningiomas (ONSM) are rare but can lead to irreversible blindness. Hybrid imaging may enhance tumor delineation and diagnostic accuracy via receptor binding. However, relevant clinical data for ONSM are lacking. We evaluated the feasibility of receptor-based hybrid imaging prior to robotic radiosurgery (RRS). We retrospectively analyzed all of our institution's patients with suspected ONSM who underwent combined positron emission tomography and magnetic resonance imaging (PET/MRI) with gallium-68-labeled (DOTA0-Phe1-Tyr3) octreotide (Ga68-DOTATOC) before RRS between 2018 and 2019. Eight patients with ten suspected ONSM (female = 7; median age, 51.2 years; IQR, 43.0-66.0) were included. Nine out of ten ONSM were deemed PET-positive with a median standard uptake value (SUV) max of 5.6 (IQR, 2.6-7.8). For all nine ONSM that presented 68Ga-DOTATOC uptake, hybrid PET/MRI was used for target volume contouring prior to RSS. At a median follow-up of 11.7 months (IQR, 9.4-16.4), tumor control was achieved in all patients. Radiosurgery resulted in the improvement of visual acuity in two of eight patients, whereas six showed stable vision. Ga68-DOTATOC-PET/MRI can be used for target volume contouring prior to RRS for ONSM as it enables safe treatment planning and improves diagnostic accuracy.
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