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62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Stereotactic radiotherapy (SRT) in the treatment of tumors compressing the optic chiasm

Meeting Abstract

Suche in Medline nach

  • K. Hamm - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt
  • G. Surber - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt
  • G. Kleinert - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt
  • S. Rosahl - Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, Neurozentrum, HELIOS Klinikum Erfurt

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.03.08

DOI: 10.3205/11dgnc195, URN: urn:nbn:de:0183-11dgnc1955

Veröffentlicht: 28. April 2011

© 2011 Hamm et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Microsurgical resection is the treatment of choice for tumors threatening the optic chiasm. However, the risk of post-operative optical impairment of sight is high and therefore the complete removal of the tumor is not always possible. To overcome this difficulty, the efficiency and side-effects of stereotactic radiotherapy (SRT) as a supplemental treatment are analysed.

Methods: Between 2000 and 2009, 266 patients with tumors touching or compressing the chiasm were treated with SRT. 151 of these (57%) were meningiomas, 92 (35%) pituitary adenomas, 15 craniopharyngiomas and 8 brain metastases. The pituitary adenomas and craniopharyngiomas were almost always relapses and progressive residual tumors after 1 – 3 microsurgical resections. In contrast, 62% of the meningiomas received SRT as the primary treatment. All of the benign tumors in close vincinity to the chiasm were treated with SRT in standard fractionation of 1.8 – 2 Gy single-dose up to a 54 or 56 Gy total dose. Hyperfractionated SRT in single doses of 4 Gy was selected for the 8 patients with brain metastases.

Results: Clinically relevant side-effects occurred in 4.4% of all cases, but without additional neurological deficits. No recurrences have been observed in the 92 patients with pituitary adenomas (100% tumor control, 53% tumor shrinkage, 3.6% one-sided visual impairment). After 4 to 8 years, 5 of the 151 meningiomas (3.3%) showed recurrent tumor growth and underwent another surgical intervention and SRT (96.7% tumor control, 54% tumor shrinkage, 2% impairment of sight). For craniopharyngiomas, the corresponding results were 93% tumor control, 73% tumor shrinkage, no optical impairment. The patients with brain metastases died after 7 to 26 months as a result of the metastatic primary tumor.

Conclusions: SRT offers an additional and/or alternative treament option with great efficiency and few side-effects, even for tumors compressing the optic chiasm. The stereotactic fractionation with 1.8 Gy single dose is decisive in order to minimize the risk of neural damage.