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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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

Meeting Abstract

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  • 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

Published: April 28, 2011

© 2011 Hamm et al.
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Outline

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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.