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Ocular and Orbital Tumors: Viewpoint-Fractionated Radiation

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Principles and Practice of Stereotactic Radiosurgery

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Abstract

Fractionated radiotherapy is a standard treatment of ocular and orbital tumors, including optic nerve sheath meningioma (ONSM). ONSM is a rare benign tumor that derivates from the arachnoid tissue. Radiotherapy has emerged as the treatment of choice for ONSM over the last two decades. While surgical resection had been seen as a standard in earlier reports, allowing the control of the intracranial extension of the tumor, as well as a definite pathological diagnosis, the high risks of functional impairment precipitating blindness secondary to optic nerve vasculature damage led to reconsider this approach.

ONSM represents a model of treatment of orbital and ocular tumors using fractionated radiotherapy, as the challenge of optic nerve preservation is amplified given the location of the tumor. Radiotherapy treatment has to be done early when visual impairment occurs. In most reports, radiotherapy has been delivered using conformal or fractionated stereotactic techniques that may control the tumor growth while preserving sensitive structures including the optic nerve and the retina, to ultimately limit the risks of visual impairment. Visual improvement is observed in 80 % of patients, tumor control in all cases, with a limited risk of radiation-induced effects. The mean eye dose has to be considered as a limiting constraint in treatment planning, and it is related to the tumor size and location. Further evaluation of the role of new radiotherapy techniques is mandatory. These points may also be considered for other ocular and orbital tumors.

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Author information

Authors and Affiliations

  1. Department of Respiratory Medicine Oncology, Hospices Civils de Lyon, 28 avenue Doyen Lépine, 69677, Lyon, France

    Nicolas Girard M.D.

  2. Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, EMR 3738, 69310, Lyon-Pierre Benite, France

    Françoise Mornex M.D., Ph.D.

  3. Neurology Service, Hospital neurologique, Université Lyon 1 et Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France

    Alain Vighetto

Authors
  1. Nicolas Girard M.D.
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  2. Françoise Mornex M.D., Ph.D.
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  3. Alain Vighetto
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Corresponding author

Correspondence to Françoise Mornex M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, USA

    Lawrence S. Chin

  2. Dept. of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, Maryland, USA

    William F. Regine

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Girard, N., Mornex, F., Vighetto, A. (2015). Ocular and Orbital Tumors: Viewpoint-Fractionated Radiation. In: Chin, L., Regine, W. (eds) Principles and Practice of Stereotactic Radiosurgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8363-2_64

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  • DOI: https://doi.org/10.1007/978-1-4614-8363-2_64

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8362-5

  • Online ISBN: 978-1-4614-8363-2

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