Narayan Samir, Cornblath Wayne T, Sandler Howard M, Elner Victor, Hayman James A
Department of Radiation Oncology, University of Michigan Health Care System, Ann Arbor, MI 48109, USA.
Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):537-43. doi: 10.1016/s0360-3016(03)00005-1.
We assessed visual outcomes, local control, and toxicity associated with three-dimensional conformal radiation therapy (3D-CRT) for primary optic nerve sheath meningiomas (ONSM).
Twenty-three patients diagnosed with ONSM were evaluated at the University of Michigan between 1986 and 2001. Fourteen patients were treated with 3D-CRT. Detailed pre- and postradiation treatment ophthalmologic examinations and MRIs were performed on all patients. Clinically significant visual acuity change was defined as a >or=three line change on the Snellen chart. Mean deviation change of >or=three decibels was defined as a clinically significant visual field change. Radiographic progression was defined as any increase in size on MRI. Acute and late toxicity was scored according to RTOG criteria.
Median follow-up was 51.3 months. Five patients had a clinically significant improvement in visual acuity. Seven had stable acuity, and only 2 worsened. Nine patients had clinically significant visual field improvement. One patient developed early radiation retinopathy, 1 experienced orbital pain, 1 developed dry eye, and 2 developed iritis. No patient has required additional treatment, and none have demonstrated radiographic progression.
3D-CRT is effective in controlling tumor growth while improving or preserving vision in most patients with optic nerve sheath meningiomas.
我们评估了三维适形放射治疗（3D-CRT）用于原发性视神经鞘膜瘤（ONSM）的视觉效果、局部控制情况及毒性。
1986年至2001年间，在密歇根大学对23例诊断为ONSM的患者进行了评估。14例患者接受了3D-CRT治疗。对所有患者进行了详细的放疗前和放疗后眼科检查及磁共振成像（MRI）。临床显著的视力变化定义为斯内伦视力表上变化≥3行。平均偏差变化≥3分贝定义为临床显著的视野变化。影像学进展定义为MRI上肿瘤大小的任何增加。根据放射肿瘤学协作组（RTOG）标准对急性和晚期毒性进行评分。
中位随访时间为51.3个月。5例患者视力有临床显著改善。7例视力稳定，仅2例视力恶化。9例患者视野有临床显著改善。1例患者发生早期放射性视网膜病变，1例出现眼眶疼痛，1例出现干眼，2例出现虹膜炎。没有患者需要额外治疗，也没有患者出现影像学进展。
3D-CRT在控制大多数视神经鞘膜瘤患者的肿瘤生长同时，能改善或保留视力，是有效的。
