Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas: A retrospective cohort study

Xinglei Shen, David W. Andrews, Robert C. Sergott, James J. Evans, Walter J. Curran, Mitchell Machtay, Ruben C Fragoso, Harriet Eldredge, Colin E. Champ, Matthew Witek, Mark V. Mishra, Adam P. Dicker, Maria Werner-Wasik

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Article number225
JournalRadiation Oncology
Volume7
Issue number1
DOIs
StatePublished - Dec 28 2012

Fingerprint

Cranial Nerve Diseases
Skull Base
Meningioma
Cohort Studies
Radiotherapy
Retrospective Studies
Visual Fields
Visual Acuity
Diplopia
Cranial Nerves
Prescriptions
Neoplasms
Logistic Models

Keywords

  • Fractionated stereotactic radiation therapy
  • Meningioma
  • Outcome
  • Skull base
  • Symptom

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas : A retrospective cohort study. / Shen, Xinglei; Andrews, David W.; Sergott, Robert C.; Evans, James J.; Curran, Walter J.; Machtay, Mitchell; Fragoso, Ruben C; Eldredge, Harriet; Champ, Colin E.; Witek, Matthew; Mishra, Mark V.; Dicker, Adam P.; Werner-Wasik, Maria.

In: Radiation Oncology, Vol. 7, No. 1, 225, 28.12.2012.

Research output: Contribution to journalArticle

Shen, X, Andrews, DW, Sergott, RC, Evans, JJ, Curran, WJ, Machtay, M, Fragoso, RC, Eldredge, H, Champ, CE, Witek, M, Mishra, MV, Dicker, AP & Werner-Wasik, M 2012, 'Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas: A retrospective cohort study', Radiation Oncology, vol. 7, no. 1, 225. https://doi.org/10.1186/1748-717X-7-225
Shen, Xinglei ; Andrews, David W. ; Sergott, Robert C. ; Evans, James J. ; Curran, Walter J. ; Machtay, Mitchell ; Fragoso, Ruben C ; Eldredge, Harriet ; Champ, Colin E. ; Witek, Matthew ; Mishra, Mark V. ; Dicker, Adam P. ; Werner-Wasik, Maria. / Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas : A retrospective cohort study. In: Radiation Oncology. 2012 ; Vol. 7, No. 1.
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AU - Shen, Xinglei

AU - Andrews, David W.

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AU - Evans, James J.

AU - Curran, Walter J.

AU - Machtay, Mitchell

AU - Fragoso, Ruben C

AU - Eldredge, Harriet

AU - Champ, Colin E.

AU - Witek, Matthew

AU - Mishra, Mark V.

AU - Dicker, Adam P.

AU - Werner-Wasik, Maria

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N2 - 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.

AB - 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.

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