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Abstract
Introduction. Optic nerve sheath meningioma (ONSM) is a rare tumor predominantly affecting adult patients, including those with neurofibromatosis type II, and is characterized by visual function impairment and exophthalmos. Management options include active surveillance, surgical resection, optic nerve decompression, radiation therapy, or combination strategies. Radiation therapy may be recommended for patients with preserved visual function, absent severe exophthalmos, and without trophic ocular changes. While conventional fractionation remains the standard radiotherapeutic approach, this study presents our institutional experience with hypofractionated stereotactic radiotherapy for ONSM.
Aim. To evaluate the safety and efficacy of hypofractionated stereotactic radiotherapy in patients with optic nerve sheath meningioma.
Materials and Methods. Between March 2010 and May 2020, 18 patients with ONSM underwent hypofractionated stereotactic radiotherapy using CyberKnife® or Novalis® platforms. The treatment protocol delivered 5.5 Gy per fraction over five fractions to a total dose of 27.5 Gy. The cohort included 16 adults (median age: 51 years; IQR: 21; range: 25–70 years) and two pediatric patients (8 and 14 years). Median tumor volume was 1.5 cm³ (range: 0.34–6.49 cm³).
Results. With a median follow-up of 57 months (range: 11–102 months; IQR: 49), tumor control was achieved in all 18 patients. Partial response (≥40% volume reduction) was observed in 5 patients (27.8%). No patients experienced visual function deterioration. Visual acuity improved in 6/14 evaluable cases (42.9%), and visual field expansion occurred in 5/8 patients (62.5%) with baseline perimetry data. Exophthalmos reduction ≥1 mm was documented in 7/14 patients (50%).
Conclusion. Hypofractionated radiation therapy demonstrates both safety and efficacy in the management of optic nerve sheath meningioma.
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