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The Value of Radiation Therapy in the Treatment of Optic Nerve Sheath Meningiomas (ONSM)
1Lübke B., 1Lieb W., 2Pfreundner L.,
1Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)
2Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Strahlenklinik (Würzburg)
Purpose: ONSM represent 1-2% of all meningiomas and are the second most common optic nerve tumor after gliomas. One third of all primary optic nerve tumors are ONSM. Until now therapy of ONSM consists partly in observation and in case of blindness in extirpation of the optic nerve. Early treatment can improve the often negative spontaneous development. Aim of radiation therapy is not a complete tumor resection, but the slowing down of the tumor progression and occasionally a tumor regression.
Method: Between 7/94 and 12/01 seven of eight patients, who presented with primary ONSM in the eyeclinic of the university of Wuerzburg, have been treated with radiation therapy. The mean age of the patients at time of diagnosis was 56 years, six of the eight patients were women, one case turned out to be bilateral. Seven patients have undergone a computer-guided stereotactic radiation therapy with daily fractions of 1.8 Gy to a cumulative dose of 45 - 50 Gy. A patient with absolute glaucoma and visual acuity of light perception was not treated. A patient with bilateral ONSM and visual acuity of 0,8 on both sides was treated on the side with the bigger tumor extension. The mean follow-up time has been 38 months. Visual loss occured to three patients due to atrophy of the optic nerve or due to central retinal and choroidal folds, no case showed tumor progression.
Results and conclusions: Stereotactic radiotherapy has been the most promising treatment modality, of which high disease control rates with stable or improved visual function have been reported. The computer-guided stereotactic provide a high accuracy and is delivered in daily fraction o 1.8 Gy to a cumulative dose of approximately 50 Gy. Other treatment modalities like stereotactic radiosurgery is critical because of the high single dose of irradiatio.