Fractionated Stereotactic Radiotherapy 'Safe and Effective' for Cranial Neuropathies in Skull Base Meningioma

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(ChemotherapyAdvisor) – Fractionated stereotactic radiotherapy (FSRT) is “a safe and effective treatment” for alleviating cranial neuropathies like visual-field defects among patients with skull base meningiomas, but the risk of local failure is high among patients with a history of previous brain radiotherapy, according to authors of a retrospective study published on the online journal Radiation Oncology.

“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,” reported lead author Xinglei Shen, MD, of the University of Kansas Medical Center's Department of Radiation Oncology in Kansas City, KS, and coauthors. “Of all symptomatic patients, 27% experienced improvement of at least one symptom within 2 months of the end of radiotherapy.”

The authors analyzed data from 225 patients diagnosed with skull base meningioma who were treated at Thomas Jefferson University with FSRT at 54 Gy standard prescription radiation dose from  1994 to 2009.

“In 92% of cases, patients were symptomatic at the time of radiotherapy; the most common were impaired visual field/acuity (58%) or extraocular movements (34%),” the authors noted. “Twenty-one patients progressed after FSRT, representing a 90.6% cumulative freedom from local failure[NR2] .”

The risk of local tumor progression after FSRT was associated with pre-FSRT radiotherapy (hazard ratio [HR] 11.02; P<0.01), the authors reported. Midline/bilateral meningioma and atypical histology were also associated with local failure (HR 2.97 and 8.70, respectively; P=0.02 and 0.01[NR3] , respectively.)

Meningiomas represent approximately 25% of primary intracranial tumors, and frequently occur at the skull base, where surgical access is challenging, the authors noted.

“Fractionated stereotactic radiation offers a safe and effective treatment option for patients with skull base meningiomas,” the authors concluded. “Over half of patients experience durable improvement in one or more symptoms, often within a few months following the start of radiation therapy.”


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