Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas: a retrospective cohort study

• Type of Material: Article
• Authors: Xinglei Shen, Thomas Jefferson University; David W. Andrews, Thomas Jefferson University; Robert C. Sergott, Thomas Jefferson University; James J. Evans, Thomas Jefferson University; Walter J Curran, Emory University; Mitchell Machtay, Case Western Reserve University; Ruben Fragoso, University of California; Harriet Eldredge, Thomas Jefferson University; Colin E. Champ, Thomas Jefferson University; Matthew Witek, Thomas Jefferson University; Mark V. Mishra, Thomas Jefferson University; Adam P. Dicker, Thomas Jefferson University; Maria Werner-Wasik, Thomas Jefferson University
• Language: English
• Date: 2012-12-28
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2012 Shen et al.; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.ro-journal.com/content/7/1/225
• Title of Journal or Parent Work: Radiation Oncology
• ISSN: 1748-717X
• Volume: 7
• Issue: 225
• Start Page: 1
• End Page: 8
• Keywords: Meningioma; Skull base; Symptom; Outcome; Fractionated stereotactic radiation therapy
• Research Categories: Health Sciences, Radiology; Health Sciences, Oncology

Abstract

Background Skull base meningiomas commonly present with cranial neuropathies. Fractionated stereotactic radiation therapy (FSRT) has been used to treat these tumors with excellent local control, but rates of improvement in cranial neuropathies have not been well defined. We review the experience at Thomas Jefferson University using FSRT in the management of these patients with a focus on symptom outcomes. Methods We identified 225 cases of skull base meningiomas treated with FSRT at Thomas Jefferson University from 1994 through 2009. The target volume was the enhancing tumor, treated to a standard prescription dose of 54 Gy. Symptoms at the time of RT were classified based on the cranial nerve affected. Logistic regression was performed to determine predictors of symptom improvement after FSRT. Results The median follow-up time was 4.4 years. In 92% of cases, patients were symptomatic at the time of RT; the most common were impaired visual field/acuity (58%) or extraocular movements (34%). After FSRT, durable improvement of at least one symptom occurred in 57% of cases, including 40% of visual acuity/visual field deficits, and 40% of diplopia/ptosis deficits. Of all symptomatic patients, 27% experienced improvement of at least one symptom within 2 months of the end of RT. Conclusions FSRT is very effective in achieving improvement of cranial neuropathies from skull base meningiomas, particularly visual symptoms. Over half of treated patients experience a durable improvement of at least one symptom, frequently within 2 months from the end of RT.