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Single fraction and hypofractionated radiosurgery for perioptic meningiomas—tumor control and visual outcomes: a systematic review and meta-analysis

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Abstract

Perioptic meningiomas, defined as those that are less than 3 mm from the optic apparatus, are challenging to treat with stereotactic radiosurgery (SRS). Tumor control must be weighed against the risk of radiation-induced optic neuropathy (RION), as both tumor progression and RION can lead to visual decline. We performed a systematic review and meta-analysis of single fraction SRS and hypofractionated radiosurgery (hfRS) for perioptic meningiomas, evaluating tumor control and visual preservation rates. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 8, 2022. We retained 5 studies reporting 865 patients, 438 cases treated in single fraction, while 427 with hfRS. For single fraction SRS, the overall rate of tumor control was 95.1%, with actuarial rates at 5 and 10 years of 96% and 89%, respectively; tumor progression was 7.7%. The rate of visual stability was 90.4%, including visual improvement in 29.3%. The rate of visual decline was 9.6%, including blindness in 1.2%. For hfRS, the overall rate of tumor control was 95.6% (range 92.1–99.1, p < 0.001); tumor progression was 4.4% (range 0.9–7.9, p = 0.01). Overall rate of visual stability was 94.9% (range 90.9–98.9, p < 0.001), including visual improvement in 22.7% (range 5.0–40.3, p = 0.01); visual decline was 5.1% (range 1.1–9.1, p = 0.013). SRS is an effective and safe treatment option for perioptic meningiomas. Both hypofractionated regimens and single fraction SRS can be considered.

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Authors and Affiliations

  1. Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA

    David R. Peters & Anthony Asher

  2. Department of Neurosurgery, Atrium Health, Charlotte, NC, USA

    David R. Peters & Anthony Asher

  3. Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    David R. Peters, Roy T. Daniel, Marc Levivier & Constantin Tuleasca

  4. Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  5. Unit of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bellaria Hospital, Bologna, Italy

    Alfredo Conti

  6. Radiation Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland

    Luis Schiappacasse

  7. Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland

    Roy T. Daniel, Marc Levivier & Constantin Tuleasca

  8. Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland

    Constantin Tuleasca

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All authors contributed to the study conception and design. Article review, article selection, and meta-analysis were performed by David Peters and Constantin Tuleasca. The first draft of the manuscript was written by David Peters and Constantin Tuleasca, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Peters, D.R., Asher, A., Conti, A. et al. Single fraction and hypofractionated radiosurgery for perioptic meningiomas—tumor control and visual outcomes: a systematic review and meta-analysis. Neurosurg Rev 46, 287 (2023). https://doi.org/10.1007/s10143-023-02197-9

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