Stereotactic Radiation Therapy in Primary Optic Nerve Sheath Meningioma
SFRT is an interesting treatment approach of patients with pONSM which combines advantages of stereotaxy and fractionation. Several institutions used SFRT in patients with progressive visual loss to achieve impressive improvements in both visual fields an
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Contents
K ey P oin t s 10.1
Introduction 105
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References 125
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10.3 Stereotactic Fractionated Radiation Therapy 107 10.3.1 Treatment Techniques 107 10.3.1.1 Thomas Jefferson University, Philadelphia (US) Approach 107 10.3.1.2 BrainLAB Technique (Barcelona, Spain) 110 10.3.1.3 University of Tuebingen, Germany Approach 115 10.3.2 Clinical Results 119
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B. Jeremić, MD, PhD International Atomic Energy Agency,Wagramer Strasse 5, P.O. Box 100, 1400 Vienna, Austria M. Werner-Wasik MD Associate Professor, Residency Program Director, Department of Radiation Oncology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia PA 19107, USA S. Villà MD, PhD Department of Radiation Oncology, Hospital Universitari Germans Trias. ICO Badalona, 08916 Badalona. Barcelona, Spain F. Paulsen, MD Klinik für Radioonkologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany G. Bednarz, MD Department of Radiation Oncology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107, USA M. Buchgeister, MD Klinik für Radioonkologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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SFRT is an interesting treatment approach of patients with pONSM which combines advantages of stereotaxy and fractionation. Several institutions used SFRT in patients with progressive visual loss to achieve impressive improvements in both visual fields and visual acuity using relatively modest doses of irradiation (mostly 45–54 Gy, using 1.8- to 2.0-Gy daily fractionation). Excellent visual outcome was almost always accompanied by low toxicity and low tumour reduction on follow-up imaging. Owing to these results, SFRT can be suggested as the new standard treatment approach in patients with pONSM and progressive visual loss.
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10.2 Stereotactic Radiosurgery 106
10.1
Introduction Stereotactic radiotherapy represents the use of radiation therapy delivered to a stereotactically localized volume of tissue (Leksell 1951, 1971). While the term stereotactic radiosurgery refers to a single-fraction delivery of a high dose of irradiation (Leksell 1971), stereo tactic fractionated radiation therapy refers to the use of fractionated irradiation, given once daily, mostly over a period of several weeks. In the last 50 years, various forms of radiation have been used, including gamma rays delivered from multiple cobalt-60 sources using the Gamma-Knife (Arndt 1993), or linear accelerator (Betti et al. 1989), or heavy particles such as helium and protons (Frankel and Phillips 1993; Kjellberg and Preston 1961). In the setting of pONSM, only stereotactic radiosurgery and stereotactic fractionated radiation therapy had been used. They are detailed below.
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B. Jeremić, M. W. Wasik, S. Villà, F. Paulsen, G. Bednarz, D. Linero and M. Buchgeister
Stereotactic Radiosurgery
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While there are well documented reports on the use of stereotactic, single fraction, radiotherapy (radiosurgery) and occasi
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