Radiotherapy and Radiosurgery in the Management of Optic Nerve Sheath Meningiomas: An International Systematic Review and Meta-Analysis of Twenty Studies.

Yash J Vaishnav, Raj Singh, Prabhanjan Didwania, Eric J Lehrer, Tatiana Bakaeva, Timothy J Harris, Michael E Migliori, Jason P Sheehan, Daniel M Trifiletti

Journal: World neurosurgery 2022;164():e929-e944

PMID: 35609728

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Optic nerve sheath meningiomas (ONMs) are often managed with radiotherapy (RT) with the goal of achieving radiographic local control (LC) and preventing deterioration of visual acuity (VA). We aimed to perform a systematic review and meta-analysis of outcomes for patients with ONM treated with RT.

METHODS

The PICOS/PRISMA/MOOSE selection criteria were used to identify studies. Primary outcomes were stable or improved VA and radiographic LC at last follow-up. The secondary outcomes were incidences of radiation-induced retinopathy and xerophthalmia and stable or improved visual fields (VFs). Weighted random-effects meta-analyses using the DerSimonian and Laird methods were conducted to characterize effect sizes. Mixed-effects regression models were used to examine potential correlations between gross tumor volume (GTV) and outcomes.

RESULTS

In total, 444 patients with ONM across 20 published studies were included. The estimated LC rate was 99.8% (95% confidence interval [CI], 98.3%-100%), and the estimated proportion of patients with stable or improved VA or VF was 89.7% (95% CI, 86.2%-92.4%) and 93.3% (95% CI, 89.5%-95.8%), respectively. Estimated incidences of radiation-induced retinopathy and xerophthalmia were 7.2% and 10.1%, respectively. GTV was significantly associated with VA (P = 0.014) with estimated VA rates of 96.4%, 91.4%, and 80.5% for GTVs of 2.0, 3.0, and 4.0 cm, respectively.

CONCLUSIONS

RT was well tolerated, with excellent LC achieved. Nearly 90% of patients noted either stability or improvement in VA and VF. Larger ONMs were associated with poorer VA.

Address: Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. Electronic address: [email protected].; Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA.; Rady School of Management, University of California San Diego, San Diego, California, USA.; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.; Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA.

DOI: 10.1016/j.wneu.2022.05.064

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MeSH Terms: Dose Fractionation, Radiation, Humans, Meningeal Neoplasms, Meningioma, Optic Nerve, Optic Nerve Neoplasms, Radiation Injuries, Radiosurgery, Retinal Diseases, Retrospective Studies, Treatment Outcome, Xerophthalmia