Skip to main content
SpringerLink
Log in

Fractionated stereotactic radiation therapy in the management of primary optic nerve sheath meningiomas

  • Clinical Study - Patient Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

We analysed our long-term results after fractionated stereotactic radiotherapy (FSRT) in patients with primary optic nerve sheath (pONSM) meningioma, as a rare subtype of meningiomas. Between 01/1995 and 12/2007, 32 patients with pONSM were treated with FSRT. Fifteen patients received radiotherapy as primary treatment, four after biopsy, and six patients after surgical resection. Seven patients were irradiated for recurrent disease. Seventeen lesions were histologically proven and determined as WHO grade I pONSM. Median target volume was 15.7 cc, median total dose 54.9 Gy. Twenty-nine patients showed clinical symptoms before radiotherapy like reduced vision, unilateral loss of vision, or an exophthalmia. Median follow-up was 4.5 years. Overall local tumor control was 100%. Twenty-six patients had stable disease based on CT/MRI, while 6/32 had a partial remission of tumor volume. 97% of our patients showed stable vision or an improvement of visual acuity. Eleven patients (38%) showed an improvement of pre-existing clinical symptoms like double vision, exophthalmia and visual acuity. Only one patient showed an impairment of vision with progressive concentric decreasing of the visual field on the side of the irradiated ONSM. These data demonstrate that FSRT is an effective and safe treatment modality for local control in patients with pONSM with minimal risk of significant late toxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rachlin JR (1991) Etiology and biology of meningiomas. In: Al-Mefty O (ed) Meningiomas. Raven Press, New York, pp 27–35

    Google Scholar 

  2. Russel DS, Rubenstein LJ (1995) Pathology of tumors of the central nervous system, 4th edn. Edward Arnold, London, pp 66–91

    Google Scholar 

  3. Dutton JJ (1992) Optic nerve sheath meningioma. Surv Ophthalmol 37:167–183. doi:10.1016/0039-6257(92)90135-G

    Article  PubMed  CAS  Google Scholar 

  4. Sibony PA, Krauss HR, Kennerdell JS et al (1984) Optic nerve sheath meningioma: clinical manifestations. Ophthalmology 91:1313–1324

    PubMed  CAS  Google Scholar 

  5. Wright JE, Call NB, Liaricos S (1980) Primary optic nerve sheath meningioma. Br J Ophthalmol 64:553–558. doi:10.1136/bjo.64.8.553

    Article  PubMed  CAS  Google Scholar 

  6. Kennerdell JS, Maroon JC, Malton M, Warren FA (1988) The management of optic nerve sheath meningiomas. Am J Ophthalmol 106:450–457

    PubMed  CAS  Google Scholar 

  7. Sarhies NJC (1987) Optic nerve sheath meningioma: diagnostic features and therapeutic alternatives. Eye 1:597–602

    Google Scholar 

  8. Mark LE, Kennerdell JS, Maroon JC et al (1978) Microsurgical removal of a primary intraorbital meningioma. Am J Ophthalmol 86:704–709

    PubMed  CAS  Google Scholar 

  9. Clark WC, Theofilos CS, Fleming JC (1989) Primary optic nerve sheath meningiomas: report of nine cases. J Neurosurg 70:37–40

    Article  PubMed  Google Scholar 

  10. Jeremic B, Pitz S (2007) Primary optic nerve sheath meningioma. Cancer 110:714–722. doi:10.1002/cncr.22859

    Article  PubMed  Google Scholar 

  11. Milker-Zabel S, Zabel A, Schulz-Ertner D et al (2005) Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningiomas—long term experience and prognostic factors. Int J Radiat Oncol Biol Phys 61(3):809–816

    PubMed  Google Scholar 

  12. Milker-Zabel S, Zabel A, Huber P et al (2006) Fractionated stereotactic radiation therapy for benign meningiomas of the cavernous sinus. Strahlenther Onkol 182(11):635–640. doi:10.1007/s00066-006-1548-2

    Article  PubMed  Google Scholar 

  13. Kumar S, Burke K, Nalder C et al (2005) Treatment accuracy of fractionated stereotactic radiotherapy. Radiother Oncol 74:51–59

    Google Scholar 

  14. Cozzi L, Clivio A, Bauman G et al (2006) Comparison of advantage irradiation techniques with photons for benign intracranial tumours. Radiother Oncol 80:268–273. doi:10.1016/j.radonc.2006.07.012

    Article  PubMed  CAS  Google Scholar 

  15. Lopatta E, Liesenfeld SM, Blank P et al (2003) Improved patient repositioning accuracy by integrating an additional jaw fixation into a high precision face mask system in stereotactic radiotherapy of the head. Strahlenther Onkol 179:571–575. doi:10.1007/s00066-003-0941-3

    Article  PubMed  Google Scholar 

  16. Debus J, Engenhart-Cabillic R, Holz FG et al (1997) Stereotactic precision radiotherapy in the treatment of intraocular malignancy with a micro-multileaf collimator. Front Radiat Ther Oncol 30:39–46

    PubMed  CAS  Google Scholar 

  17. Milker-Zabel S, Henze M, Zabel A et al (2006) Improved target volume definition in patients with intracranial meningiomas by correlation of CT, MRI and [68Ga]-DOTATOC PET for fractionated stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 65(1):222–227. doi:10.1016/j.ijrobp.2005.12.006

    PubMed  Google Scholar 

  18. Debus J, Engenhart-Cabillic R, Knopp MV et al (1996) Bildorientierte Planung minimalinvasiver konformierender Bestrahlungsverfahren im Kopf-Hals-Bereich. Radiologe 36:732–736. doi:10.1007/s001170050135

    Article  PubMed  CAS  Google Scholar 

  19. Höss A, Debus J, Bendl R et al (1995) Computerverfahren in der dreidimensionalen Strahlentherapieplanung. Radiologe 35:583–586

    PubMed  Google Scholar 

  20. Schlegel W, Pastyr O, Bortfeld T et al (1992) Computer systems and mechanical tools for stereotactically guided conformation therapy with linear accelerators. Int J Radiat Oncol Biol Phys 24:781–787

    PubMed  CAS  Google Scholar 

  21. Andrews DW, Faroozan R, Yang BP et al (2002) Fractionated stereotactic radiotherapy for the treatment of optic nerve sheath meningiomas: preliminary observations of 33 optic nerves in 30 patients with historical comparison to observation with or without prior surgery. Neurosurgery 51:890–904. doi:10.1097/00006123-200210000-00007

    Article  PubMed  Google Scholar 

  22. Becker G, Jeremic B, Pitz S et al (2002) Stereotactic fractionated radiotherapy in patients with optic nerve sheath meningiomas. Int J Radiat Oncol Biol Phys 54:1422–1429. doi:10.1016/S0360-3016(02)03753-7

    PubMed  Google Scholar 

  23. Pitz S, Schiefer U, Wilhelm H et al (2002) Stereotactic fractionated irradiation of optic nerve sheath meningioma: a new treatment alternative. Br J Ophthalmol 86:1265–1268. doi:10.1136/bjo.86.11.1265

    Article  PubMed  CAS  Google Scholar 

  24. Subramanian PS, Bressler NM, Miller NR (2004) Radiation retinopathy after fractionated stereotactic radiotherapy for optic nerve sheath meningioma. Ophthalmology 111:565–567

    Article  PubMed  Google Scholar 

  25. Becker G, Kocher M, Kortmann RD et al (2002) Rating of radiation therapy in the multimodal treatment approach of pituitary adenomas. Strahlenther Onkol 178:173–186. doi:10.1007/s00066-002-0826-x

    Article  PubMed  Google Scholar 

  26. Litre CF, Noudel R, Colin P et al (2007) Fractionated stereotactic radiotherapy for optic nerve sheath meningioma: eight cases. Neurochirurgie 53:333–338

    PubMed  CAS  Google Scholar 

  27. Baumert BG, Villa S, Studer G et al (2004) Early improvement in vision after fractionated stereotactic radiotherapy for primary optic nerve sheath meningioma. Radiother Oncol 72:169–174. doi:10.1016/j.radonc.2004.04.008

    Article  PubMed  Google Scholar 

  28. Narayan S, Cornblath WT, Sandler HM et al (2003) Preliminary visual outcomes after three-dimensional conformal radiation therapy for optic nerve sheath meningioma. Int J Radiat Oncol Biol Phys 56:537–543. doi:10.1016/S0360-3016(03)00005-1

    Article  PubMed  Google Scholar 

  29. Parsons JT, Bova FJ, Fitzgerald CR et al (1994) Radiation optic neuropathy after megavoltage external beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys 30:755–763

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Radiotherapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Stefanie Milker-Zabel, Jürgen Debus & Angelika Zabel-du Bois

  2. Department of Radiotherapy, German Cancer Research Center, Heidelberg, Germany

    Peter Huber & Angelika Zabel-du Bois

  3. Department of Medical Physics, German Cancer Research Center, Heidelberg, Germany

    Wolfgang Schlegel

Authors
  1. Stefanie Milker-Zabel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Huber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolfgang Schlegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jürgen Debus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelika Zabel-du Bois
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefanie Milker-Zabel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Milker-Zabel, S., Huber, P., Schlegel, W. et al. Fractionated stereotactic radiation therapy in the management of primary optic nerve sheath meningiomas. J Neurooncol 94, 419–424 (2009). https://doi.org/10.1007/s11060-009-9874-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-009-9874-8

Keywords

Search

Navigation