Radiosurgical decompression for benign perioptic tumors causing compressive cranial neuropathies

a feasible alternative to microsurgery?

Eun Jung Lee, Young Hyun Cho, Kyoung Jun Yoon, Byungchul Cho, Eun Suk Park, Chang Jin Kim, Sung Woo Roh

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Several studies have reported the efficacy and safety of hypofractionated stereotactic radiosurgery (hSRS) in the treatment of benign perioptic tumors. This study went further and evaluated the feasibility of hSRS in the treatment of those causing compressive cranial neuropathies (CCNs) among perioptic tumors with special consideration of functional improvement. Twenty-six patients with CCNs (CN II = 19; CN III/IV/VI = 9; CN V = 3) caused by perioptic tumors underwent hSRS between 2011 and 2015. hSRS was delivered in five fractions with a median marginal dose of 27.8 Gy (≈14 Gy in a single fraction, assuming an α/β of three) to a tumor volume of 8.2 ± 8.3 cm 3 . All tumors except one shrank after treatment, with a mean volume decrease of 35 % (range 4−84 %) during the mean follow-up period of 20 months. In 19 patients (38 eyes) with compressive optic neuropathy, vision improved in 55.3 % of eyes (n = 21), was unchanged in 36.8 % (n = 14), and worsened in 7.9 % (n = 3) (2.6 % after excluding two eyes deteriorated due to transient tumor swelling). A higher conformity index (p = 0.034) and volume of the optic apparatus receiving >23.0 Gy (p = 0.019) were associated with greater tumor shrinkage. A greater decrease in tumor volume (p = 0.035) was associated with a better improvement in vision. Ophthalmoplegia and facial hypesthesia improved in six of nine (66.7 %) and three of three (100 %) patients, respectively. There was no newly developed neurological deficit. Decompressive SRS for benign perioptic tumors causing CCN is feasible using hypofractionation, representing a useful alternative to microsurgical resection.

Original languageEnglish
Pages (from-to)73-81
Number of pages9
JournalJournal of Neuro-Oncology
Volume131
Issue number1
DOIs
StatePublished - 1 Jan 2017
Externally publishedYes

Fingerprint

Cranial Nerve Diseases
Microsurgery
Decompression
Radiosurgery
Neoplasms
Tumor Burden
Ophthalmoplegia
Optic Nerve Diseases
Hypesthesia
Therapeutics
Safety

Keywords

  • Cranial neuropathy
  • Dose fractionation
  • Optic pathway
  • Radiation-induced optic neuropathy
  • Stereotactic radiosurgery
  • Visual outcome

Cite this

Lee, Eun Jung ; Cho, Young Hyun ; Yoon, Kyoung Jun ; Cho, Byungchul ; Park, Eun Suk ; Kim, Chang Jin ; Roh, Sung Woo. / Radiosurgical decompression for benign perioptic tumors causing compressive cranial neuropathies : a feasible alternative to microsurgery?. In: Journal of Neuro-Oncology. 2017 ; Vol. 131, No. 1. pp. 73-81.
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title = "Radiosurgical decompression for benign perioptic tumors causing compressive cranial neuropathies: a feasible alternative to microsurgery?",
abstract = "Several studies have reported the efficacy and safety of hypofractionated stereotactic radiosurgery (hSRS) in the treatment of benign perioptic tumors. This study went further and evaluated the feasibility of hSRS in the treatment of those causing compressive cranial neuropathies (CCNs) among perioptic tumors with special consideration of functional improvement. Twenty-six patients with CCNs (CN II = 19; CN III/IV/VI = 9; CN V = 3) caused by perioptic tumors underwent hSRS between 2011 and 2015. hSRS was delivered in five fractions with a median marginal dose of 27.8 Gy (≈14 Gy in a single fraction, assuming an α/β of three) to a tumor volume of 8.2 ± 8.3 cm 3 . All tumors except one shrank after treatment, with a mean volume decrease of 35 {\%} (range 4−84 {\%}) during the mean follow-up period of 20 months. In 19 patients (38 eyes) with compressive optic neuropathy, vision improved in 55.3 {\%} of eyes (n = 21), was unchanged in 36.8 {\%} (n = 14), and worsened in 7.9 {\%} (n = 3) (2.6 {\%} after excluding two eyes deteriorated due to transient tumor swelling). A higher conformity index (p = 0.034) and volume of the optic apparatus receiving >23.0 Gy (p = 0.019) were associated with greater tumor shrinkage. A greater decrease in tumor volume (p = 0.035) was associated with a better improvement in vision. Ophthalmoplegia and facial hypesthesia improved in six of nine (66.7 {\%}) and three of three (100 {\%}) patients, respectively. There was no newly developed neurological deficit. Decompressive SRS for benign perioptic tumors causing CCN is feasible using hypofractionation, representing a useful alternative to microsurgical resection.",
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Radiosurgical decompression for benign perioptic tumors causing compressive cranial neuropathies : a feasible alternative to microsurgery? / Lee, Eun Jung; Cho, Young Hyun; Yoon, Kyoung Jun; Cho, Byungchul; Park, Eun Suk; Kim, Chang Jin; Roh, Sung Woo.

In: Journal of Neuro-Oncology, Vol. 131, No. 1, 01.01.2017, p. 73-81.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Radiosurgical decompression for benign perioptic tumors causing compressive cranial neuropathies

T2 - a feasible alternative to microsurgery?

AU - Lee, Eun Jung

AU - Cho, Young Hyun

AU - Yoon, Kyoung Jun

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AU - Park, Eun Suk

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AU - Roh, Sung Woo

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AB - Several studies have reported the efficacy and safety of hypofractionated stereotactic radiosurgery (hSRS) in the treatment of benign perioptic tumors. This study went further and evaluated the feasibility of hSRS in the treatment of those causing compressive cranial neuropathies (CCNs) among perioptic tumors with special consideration of functional improvement. Twenty-six patients with CCNs (CN II = 19; CN III/IV/VI = 9; CN V = 3) caused by perioptic tumors underwent hSRS between 2011 and 2015. hSRS was delivered in five fractions with a median marginal dose of 27.8 Gy (≈14 Gy in a single fraction, assuming an α/β of three) to a tumor volume of 8.2 ± 8.3 cm 3 . All tumors except one shrank after treatment, with a mean volume decrease of 35 % (range 4−84 %) during the mean follow-up period of 20 months. In 19 patients (38 eyes) with compressive optic neuropathy, vision improved in 55.3 % of eyes (n = 21), was unchanged in 36.8 % (n = 14), and worsened in 7.9 % (n = 3) (2.6 % after excluding two eyes deteriorated due to transient tumor swelling). A higher conformity index (p = 0.034) and volume of the optic apparatus receiving >23.0 Gy (p = 0.019) were associated with greater tumor shrinkage. A greater decrease in tumor volume (p = 0.035) was associated with a better improvement in vision. Ophthalmoplegia and facial hypesthesia improved in six of nine (66.7 %) and three of three (100 %) patients, respectively. There was no newly developed neurological deficit. Decompressive SRS for benign perioptic tumors causing CCN is feasible using hypofractionation, representing a useful alternative to microsurgical resection.

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