title: Visual outcome in meningiomas around anterior visual pathways treated with linear accelerator fractionated stereotactic radiotherapy.
abstract: OBJECTIVE
  Meningiomas threatening the anterior visual pathways (AVPs) and not amenable for surgery are currently treated with multisession stereotactic radiotherapy. Stereotactic radiotherapy is available with a number of devices. The most ubiquitous include the gamma knife, CyberKnife, tomotherapy, and isocentric linear accelerator systems. The purpose of our study was to describe a case series of AVP meningiomas treated with linear accelerator fractionated stereotactic radiotherapy (FSRT) using the multiple, noncoplanar, dynamic conformal rotation paradigm and to compare the success and complication rates with those reported for other techniques.
  
  
  METHODS
  We included all patients with AVP meningiomas followed up at our neuro-ophthalmology unit for a minimum of 12 months after FSRT. We compared the details of the neuro-ophthalmologic examinations and tumor size before and after FSRT and at the end of follow-up.
  
  
  RESULTS
  Of 87 patients with AVP meningiomas, 17 had been referred for FSRT. Of the 17 patients, 16 completed >12 months of follow-up (mean 39). Of the 16 patients, 11 had undergone surgery before FSRT and 5 had undergone FSRT as first-line management. Tumor control was achieved in 14 of the 16 patients, with three meningiomas shrinking in size after RT. Two meningiomas progressed, one in an area that was outside the radiation field. The visual function had improved in 6 or stabilized in 8 of the 16 patients (88%) and worsened in 2 (12%).
  
  
  CONCLUSIONS
  Linear accelerator fractionated RT using the multiple noncoplanar dynamic rotation conformal paradigm can be offered to patients with meningiomas that threaten the anterior visual pathways as an adjunct to surgery or as first-line treatment, with results comparable to those reported for other stereotactic RT techniques.
authors.affiliation: Neuro-Ophthalmology Unit, Rabin Medical Center, Petah Tikva, Israel. kalishhadas@gmail.com
authors.forename: Hadas
authors.initials: H
authors.lastname: Stiebel-Kalish
authors.forename: Ehud
authors.initials: E
authors.lastname: Reich
authors.forename: Lior
authors.initials: L
authors.lastname: Gal
authors.forename: Zvi Harry
authors.initials: ZH
authors.lastname: Rappaport
authors.forename: Ouzi
authors.initials: O
authors.lastname: Nissim
authors.forename: Raphael
authors.initials: R
authors.lastname: Pfeffer
authors.forename: Roberto
authors.initials: R
authors.lastname: Spiegelmann
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D058958:Organs at Risk; D016634:Radiosurgery / Q000379:methods*; D047368:Tumor Burden / Q000528:radiation effects; D014786:Vision Disorders / Q000209:etiology / Q000601:surgery; D014795:Visual Pathways