title: Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas: a retrospective cohort study.
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.
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA. xshen@kumc.edu
authors.forename: Xinglei
authors.initials: X
authors.lastname: Shen
authors.forename: David W
authors.initials: DW
authors.lastname: Andrews
authors.forename: Robert C
authors.initials: RC
authors.lastname: Sergott
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
authors.forename: Ruben
authors.initials: R
authors.lastname: Fragoso
authors.forename: Harriet
authors.initials: H
authors.lastname: Eldredge
authors.forename: Colin E
authors.initials: CE
authors.lastname: Champ
authors.forename: Matthew
authors.initials: M
authors.lastname: Witek
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mishra
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dicker
authors.forename: Maria
authors.initials: M
authors.lastname: Werner-Wasik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010315:Particle Accelerators; D010523:Peripheral Nervous System Diseases / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult