Radiotherapy for the treatment of optic nerve sheath meningioma: A systematic review and meta-analysis

  • Laísa Pereira de Melo
    Affiliations
    Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil
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  • Gustavo Arruda Viani
    Correspondence
    Corresponding author at: Radiotherapy Department, Ribeirão Preto Medical School Hospital and Clinics, University of São Paulo, Av. Bandeirantes, 3900, 14.049-900 Ribeirão Preto, São Paulo, Brazil.
    Affiliations
    Department of Image Sciences and Medical Physics, Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil
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  • Jayter Silva de Paula
    Affiliations
    Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil
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Published:October 21, 2021DOI:https://doi.org/10.1016/j.radonc.2021.10.009

      Highlights

      • Radiotherapy shown excellent tumor control rate for the treatment of optic nerve sheath meningiomas (ONSM).
      • The 3D-conformal radiotherapy (3CRT) was associated with more complications.
      • New radiation modalities such as intensity-modulated RT (IMRT), stereotactic radiosurgery (SRS), proton beam therapy (PBT), stereotactic fractionation RT (SFRT) resulted in better therapeutic indexes, compared to 2DRT and 3CRT.

      Abstract

      Objectives

      The management of Optic Nerve Sheath Meningiomas (ONSM) has suffered a significant shift due to new radiation techniques. However, there is no conclusive information on which approach presents better results in the literature. This meta-analysis aims to evaluate the outcomes of different radiotherapy (RT) modalities in the management of ONSM.

      Methods

      A systematic review based on an electronic search was performed in MEDLINE, EMBASE, Cochrane, and Lilacs databases. Eligible studies included patients with ONSM treated with RT. Two reviewers independently assessed the eligibility of potential studies, extracted data, and performed the meta-analysis. Outcomes of interest were tumor control, visual acuity (VA), visual field, and complications.

      Results

      Thirty-nine non-comparative studies involving 736 eyes with ONSM treated with RT were included. Six different techniques were studied: 2-dimensional RT (2DRT), 3D-conformal RT (3CRT), Stereotactic Fractionation RT (SFRT), stereotactic radiosurgery (SRS), intensity-modulated RT (IMRT), and proton beam therapy (PBT). With a mean follow-up period of 46 months, tumor control was 97,4% (95% CI: 98–100%). No difference was observed regarding the rate of final VA post-treatment among the modalities. The 3CRT showed substantially higher rates of complication than other techniques.

      Conclusions

      RT produces remarkable tumor control. New radiation modalities such as SFRT, IMRT, SRS, and PBT resulted in better therapeutic results with fewer complications than 2DRT and 3CRT. Thus, they should be the preferential choices for treating ONSM regardless of initial clinical presentation.

      Keywords

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