Multisession Radiosurgery for Sellar and Parasellar Benign Meningiomas: Long-term Tumor Growth Control and Visual Outcome.
BACKGROUND
Concern about radiation-induced optic neuropathy (RION) has governed recent thinking about the role of radiation therapy in the treatment of meningiomas involving the anterior optic pathways. Despite this concern, during the last few years, the use of radiosurgery for such lesions has increased steadily.


OBJECTIVE
To define both the tumor control rate and the risk of RION over a long-term follow-up period in a large cohort of patients treated with multisession radiosurgery.


METHODS
The local control and visual outcome of 143 patients who underwent multisession radiosurgery (mRS) were evaluated. Neurological outcome was also analyzed. The data for the present study were obtained from a prospectively maintained database.


RESULTS
The mean follow-up was 44 months (range, 12-113 months). All patients underwent mRS. The median prescription dose was 25 Gy delivered in 3 to 5 fractions. The prescription isodose, which typically encompassed at least 95% of the tumor, ranged from 65% to 86% (median, 80%). The mean tumor volume was 11.0 cm (range, 0.1-126.3 cm; median, 8 cm). The progression-free survival at 3, 5, and 8 years was 100%, 93%, and 90%, respectively. Compared with baseline, visual function improved in 36% of patients, whereas 7.4% experienced a worsening in visual function (5.1% excluding the patients with progressive disease).


CONCLUSIONS
Good local control rate and a low risk of RION indicate that mRS is a safe and effective treatment option in cases of large meningiomas.
*Radiotherapy Unit, Department of Neurosurgery,§Neuroepidemiology Unit,¶Health Department, and‖Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy;‡Neuroophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Marcello
M
Marchetti
Stefania
S
Bianchi
Valentina
V
Pinzi
Irene
I
Tramacere
Maria Luisa
ML
Fumagalli
Ida Maddalena
IM
Milanesi
Paolo
P
Ferroli
Angelo
A
Franzini
Marco
M
Saini
Francesco
F
DiMeco
Laura
L
Fariselli
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012658:Sella Turcica; D016896:Treatment Outcome; D014785:Vision, Ocular; D055815:Young Adult