Open Access Research

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

Xinglei Shen17*, David W Andrews2, Robert C Sergott3, James J Evans2, Walter J Curran4, Mitchell Machtay5, Ruben Fragoso6, Harriet Eldredge18, Colin E Champ18, Matthew Witek18, Mark V Mishra18, Adam P Dicker18 and Maria Werner-Wasik18

Author Affiliations

1 Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA

2 Department of Neurologic Surgery, Thomas Jefferson University, 909 Walnut St, 3rd Floor, Philadelphia, PA, 19107, USA

3 Neuro-ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Waltnut St., Suite 930, Philadelphia, PA, 19107, USA

4 Department of Radiation Oncology, Winship Cancer Institute, Emory University, 1365 Clifton Road Northeast, Atlanta, GA, 30322, USA

5 Department of Radiation Oncology, University Hospitals, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA

6 Department of Radiation Oncology, University of California–UC Davis Cancer Center, 4501 X Street, Suite 0140, Sacramento, CA, 95817, USA

7 Department of Radiation Oncology, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 4033, Kansas City, KS, 66160, USA

8 Department of Radiation Oncology, Thomas Jefferson University Hospital, Bodine Cancer Center, 111 S. 11th Street, Philadelphia, PA, 19107, USA

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Radiation Oncology 2012, 7:225  doi:10.1186/1748-717X-7-225

Published: 28 December 2012

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.

Keywords:
Fractionated stereotactic radiation therapy; Meningioma; Symptom; Outcome; Skull base