Artikel
Stereotactic radiotherapy of meningiomas compressing optical pathways
Stereotaktische Radiotherapie bei das optische System komprimierenden Meningeomen
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Autoren
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K. Hamm
- Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, HELIOS Klinikum Erfurt
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M. Henzel
- Klinik für Strahlentherapie, Philipps-Universität Marburg
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M. Gross
- Klinik für Strahlentherapie, Philipps-Universität Marburg
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G. Surber
- Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, HELIOS Klinikum Erfurt
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G. Kleinert
- Abteilung für stereotaktische Neurochirurgie und Radiochirurgie, HELIOS Klinikum Erfurt
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R. Engenhart-Cabillic
- Klinik für Strahlentherapie, Philipps-Universität Marburg
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Microsurgical resection is usually the treatment of choice for meningiomas, especially for those compressing the optical pathways. However, in many cases of skull base meningiomas there is a high risk of neurological deficits and recurrences in cases where complete tumour removal was not possible. In such cases (fractionated) stereotactic radiotherapy (SRT) can offer an alternative treatment option. We evaluated local control rates, symptoms and toxicity.
Methods: 183 patients with skull base meningiomas were treated between 1997 and 2003 with SRT, among them 65 with meningiomas compressing optical pathways (64 benign, 1 atypical). Of these 65 cases, 20 of these were treated with SRT only, 27 were subtotally resected before SRT, and 18 underwent multiple tumour resections before SRT. We investigated the results up until now with a median follow-up of 45 months (range: 22-83 months). The tumour volume (TV = gross tumour volume) ranged from 0.61 to 90.20 ccm (mean: 18.9 ccm). Due to the risk of causing new visual disturbances, the dose per fraction was either 2 or 1.8 Gy for all patients, leading to a total dose of 50-60 Gy.
Results: The overall survival and the progression-free survival rates for 5 years were assessed to 100% in this patient group. To date, no progression for these meningiomas has been observed. Quantitatively, tumour shrinkage of more than 20%, or more than 2 mm in diameter, was proved in 35 of the 65 cases after SRT. In 29 of the 65 patients at least 1 of the symptoms improved. Applying the Common Toxicity Criteria (CTC) acute toxicity (grade 3) was seen in 1 case (worsening of conjunctivitis). Another 2 patients developed late toxicity by LENT-SOMA score, 1 x grade 1 and 1 x grade 3 (field of vision loss).
Conclusions: As a low risk and effective treatment option for tumour control, SRT with 1.8-2.0 Gy per fraction can also be recommended in case of meningiomas compressing optical pathways. An interdisciplinary decision is very important for each patient.
