Table 1.
Summary of radiotherapy treatment for ONSM
| Paper | Eyes (n) | Years | Radiotherapy type | Median dose; fraction (Gy) | Median follow-up (months) | V/A
|
VF | Radiographic outcome | Toxicity (number of patients) | Others | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Improved | Stable | Worse dose per | ||||||||||
| Fineman and | 1 | 1999 | FSRT | 54; 1.8 | 6 | – | 1/1 | – | – | 100% control | Nil | |
| Ausberger 199975 | 1/1 stable | 100% reduction in volume | Nil | |||||||||
| Paridaens et al 200365 | 1 | 2000 | FSRT | 54; 1.8 | 16 | 1/1 | – | – | 5/16 improved, 11/16 stable | 100% control | Alopecia (11), erythema (5) | |
| 4/5 improved, 1/5 stable | 100% control | Nausea (1), periorbital edema (1) | ||||||||||
| Pitz et al 200267 | 16 | 1989–2000 | FSRT | 54; 1.8 | 37 (mean) | 1/16 | 15/16 | – | 6/14 improved, 8/14 stable | 100% control | Erythema (5), alopecia (11), endocrine defects (2) | Study also included data for secondary ONSM, which had better outcomes than primary ONSM |
| Liu et al 200268 | 5 | 1994–2001 | FSRT | 45–54; 1.8 | 24 | 4/5 | 1/5 | – | 10/24 improved, 12/24 stable, 2/24 deteriorated | 100% control, four smaller | Optic neuritis (1), pain (1) | No distinction between V/A and VF |
| Becker et al 200271 | 16 | 1994–2000 | FSRT | 54; 1.8 (plus 2× boost doses of 3.6) | 35.5 | 1/16 | 15/16 | – | Stable, then decreased | 100% control | Optic neuropathy (1) | |
| Andrews et al 200273 | 33 (22 with useful vision) | 1996–2001 | FSRT | 50–54; 1.8 | 21 | 10/24 | 12/24 | 2/24 | 8/21 improved, 11/21 stable, 2/21 decrease | 100% control, one decreased | Pain (1), lid edema (1), alopecia (all), headache (1), retinopathy (1) | |
| Saeed et al 200332 | 1 | 2003 | FSRT | 45; 1.6 | 12 | – | 1/1 | – | 1/1 reduced | 100% control | Retinopathy | Initial improvement, but retinopathy after 2 years |
| Baumert et al 200472 | 23 | 1996–2003 | FSRT | 45–54; 1.8–2.0 | 20 | 16/22 | 5/22 | 1/22 | 3/4 improved, 1/4 deteriorated | 100% control | Alopecia (1) | |
| Subramanian et al 2004106 | 1 | 2004 | FSRT | 54; 1.8 | 64 | – | – | 1/1 | Four improved, two stable, one deteriorated | 100% control, one decreased | Periorbital edema (1) | |
| Richards et al 200562 | 4 | 1999–2002 | FSRT | 43–45; 1.6–1.8 | 24 | 1/4 | 3/4 | – | 5/23 improved, 18/23 stable, none worse | 100% control, 19% response (response =25% reduction in volume) | Alopecia (most), dizziness (1), lacrimal hypersecretion (3), visual deterioration (1) | |
| Landert et al 200570 | 7 | 1989–2000 | FSRT | 54 (50–54); 1.7/1.8 | 57 (mean) | 5/7 | 1/7 | 1/7 | 36% improved | 95% control | Headache/pain (2), asymptomatic retinopathy (3) | Delivered by either proton or photon radiotherapy |
| Milker-Zabel et al 200969 | 32 | 1995–2007 | FSRT | 54.9 (50.4–57.6); 1.8 | 54 | 5/23 | 17/23 | 1/23 | 21% improved | – | Total/34: Alopecia (12), erythema (16), headache (6), dry eye (5), cataract (3), retinopathy (6) | |
| Arvold et al 200964 | 25 | 1999–2006 | FSRT | 50.4; 1.8 | 30 | 14/22 | 7/22 | 1/22 | ||||
| Saeed et al 201055 | 12 | 1998–2008 | FSRT | 45; 1.8 | 58 | 5/12 | 6/12 | 1/12 | 2/2 improved | 100% control | Headache (1), fatigue (1) | |
| Lesser et al 201058 | 2 | 1996–2009 | FSRT | 52.2–54.0; fractions not specified | 138 | 1/2 | 1/2 | – | – | 100% control | Pain (1), conjunctivitis (1) | |
| Pacelli et al 201163 | 5 | 2007–2009 | FSRT | 50.4; 1.8 | 26 | 2/5 | 3/5 | – | – | 100% | Overall/40: Alopecia (most), fatigue (8), dry eye (2), conjunctivitis (1), headache (1), hyperlacrimation (3) | Exact V/A and field outcomes not reported directly Only patients who received primary external beam radiotherapy have been included here |
| Adeberg et al 201151 | 19 | 1991–2010 | FSRT | 54 (25–66); 1.8–5 | 60 | 9/19 | – | – | – | 100% control | Alopecia (some), fatigue (some), retinopathy (2), embolic CRAO (1) | Improvement defined by ophthalmologist report or patient subjective report |
| Solda et al 201274 | 46 | 1997–2010 | FSRT | 54; 1.5–1.7 | 30 | 13/41 | 24/41 | 4/41 | 16/91 improved, 67/91 stable, | 100% control at 3 years, | Alopecia (66), erythema (38), pain (32), | Primary ONSM n=37, secondary |
| Paulsen et al 201266 | 113 | 1993–2005 | FSRT | 54; 1.8 | 30 (clinical) 53 (ophthal) 42 (imaging) |
12/91 | 68/91 | 11/91 | 8/91 reduced | 98% at 5 years | nausea (11), hydrocephalus (2), vertigo (13), raised ICP (11) | ONSM n=76. Results not reported separately, but no significant difference between each type |
| Moyer et al 200054 | 1 | 2000 | 3D-CRT | 50.4; 1.8 | 24 | 1/1 | – | – | 1/1 improved | 1/1 slight decrease | – | |
| Narayan et al 200356 | 14 | 1986–2001 | 3D-CRT | 50.4–56; 1.8–2.0 | 51 | 5/14 | 7/14 | 2/14 | 14/14 improved | 100% control, one decreased | Keratitis (1), dry eye (1), retinopathy (1), pain (1), iritis (2) | |
| Saeed et al 201055 | 22 | 1998–2008 | 3D-CRT | 50.4–54.0; 1.8 | 58 | 9/22 | 11/22 | 2/22 | 21% improved | – | Total 34 Alopecia (12), erythema (16), headache (6), dry eye (5), cataract (3), retinopathy (6) | |
| Lesser et al 201058 | 8 | 1996–2009 | 3D-CRT | 45–52.19; fractions not specified | 89.6 | 1/8 | 7/8 | 0/8 | 2/8 improved, 5/8 stable, 1/8 unrecorded | 2/8 reduced, 6/8 stable | Alopecia (3), fatigue (5), nausea (1), dry eye (1) | |
| Metellus et al 201157 | 32 | 1995–2002 | 3D-CRT | 50.4; 1.8 | 90 | 4/9 | 4/9 | 1/9 | 6/9 improved, 3/9 stable | 100% control, two decreased | Retinopathy (1), pain and swelling (1) | |
| Abouaf et al 201259 | 7 | 1998–2009 | 3D-CRT, 2D-CRT | 50–64; 1.8–2.0 | 51 | 4/7 | 0/7 | 3/7 | 3/7 improved, 2/7 stable, 2/7 decreased | 100% control, two reduced | Cataract (3), retinopathy (3), dry eye (1), blepharitis/conj (3), fatigue (3), alopecia (1) | |
| Adams et al 201360 | 18 | 1996–2011 | 3D-CRT | 46.8–55.8; 1.8 | 64 | 5/13 | 3/13 | 5/13 | – | 100% control, 10 reduced | Alopecia (8), headache (2), otitis externa (1), dry mouth (1), conjunctivitis (1), dry eye (5), cataract (4), disc atrophy (2) | Results for any change in visual acuity. |
| Lee et al 199661 | 1 | 1996 | IMRT | 50.4; 1.8 | 1 week | 1/1 | – | – | 1/1 | 100% control | Nil | For comparison with other studies, 89% of patients were stable or improved (≥2 Snellen lines) |
| Grant et al 199878 | 1 | 1998 | IMRT | 50; 2 | 36 | – | 1/1 | – | 1/1 improved field | – | Nil | Uncertain if this is the same patient as Lee et al 1996, but different radiotherapy parameters |
| Maclean et al 201377 | 3 | 2007–2011 | IMRT | 50.4; 1.8 | 28 | 6.6% | 93.3% | – | 5/16 improved, remainder stable | 2/30 reduced, 27/30 stable, 1/30 progressed | Dry eye (5), keratitis (2), field loss (1) | Results for whole series, applied to ONSM as no significant difference between groups |
| Lesser et al 201058 | 1 | 1996–2009 | IMRT | 45.0; fractions not | 91 | – | 1/1 | – | 1/1 field stable | 1/1 decreased | Questionable early menopause | |
| specified | 3/3 improved | 100% control | Cataract (3), dry eye (1), blepharitis (1) | |||||||||
| Abouaf et al 201259 | 3 | 1998–2009 | IMRT | 50–64; 1.8–2.0 | 51 | 2/3 | 1/3 | 0/3 | 1/1 stable | 100% control | Headache (1), edema (1) | |
| Klink et al 199880 | 1 | 1992 | SRS | 36; 6 | 24 | – | 1/1 | – | 6/17 improved, 11/17 stable 4/5 improved | 90% control, 10% reduction in size | Abnormal lacrimation (2), neuropathy (1), dizziness (1) | |
| Marchetti et al 201179 | 21 | 2004–2008 | SRS | 25; 5 | 30 (mean) | 4/15 | 11/15 | – | 100% control | – | Includes patients reported in Romanelli 2007 | |
| Romanelli et al 201181 | 5 | – | SRS | 20; 5 | 78 | 4/5 | 1/5 | – | – | 100% control within radiation field | – | One patient had recurrence outside the treated field of radiation |
| Smee et al 200952 | 16 | 1990–2004 | 3D-CRT, FSRT, IMRT, SRS | – | – | 15/16 | 1/16 | No statistics used so difficult to compare quantitatively | ||||
Note: Where results for V/A of visual fields were reported for the cohort including but not exclusively limited to ONSMs, a “%” result was given.
Abbreviations: CRAO, central retinal artery occlusion; 3D-CRT, three-dimensional conformal radiotherapy; 2D-CRT, two-dimensional conformal radiotherapy; conj, conjunctivitis; FSRT, fractionated stereotactic radiotherapy; ICP, intracranial pressure; IMRT, intensity modulated radiotherapy; ONSM, optic nerve sheath meningioma; SRS, stereotactic radiosurgery; V/A, visual acuity; VF, visual field.