Moyal L, Vignal-Clermont C, Boissonnet H, Alapetite C
Fondation ophtalmologique Adolphe-de-Rothschild, service des urgences et de neuro-ophtalmologie, 25, rue Manin, 75019 Paris, France.
Fondation ophtalmologique Adolphe-de-Rothschild, service des urgences et de neuro-ophtalmologie, 25, rue Manin, 75019 Paris, France.
J Fr Ophtalmol. 2014 Apr;37(4):288-95. doi: 10.1016/j.jfo.2013.09.006. Epub 2014 Mar 13.
Optic nerve sheath meningioma (ONSM) is a common benign neoplasm arising from the arachnoid tissue encapsulating the optic nerve and affects mainly middle aged women. It is a slow-growing tumor for which there is still no consensus on treatment.
To evaluate the safety and efficacy of fractionated targeted proton beam therapy (PBT) in the treatment of ONSM and to define its role in the treatment of these tumors.
We performed a retrospective analysis of 15 patients (13 women and 2 men), mean age 41.8 years, presenting with primary ONSM, followed at the Fondation Ophtalmologique Adolphe de Rothschild (Paris) between September 2006 and August 2013. After a multidisciplinary consultation, all were treated with PBT at a total dose of 52.2 Gy Eco, in fractions of 1.8 Gy Eco, at the Institut Curie (Paris). Patients underwent standardized follow-up including ophthalmologic examinations, visual field testing and imaging every 6 months. Study parameters were post-treatment visual acuity, tumor size on MRI, and treatment side effects
We separated the patients into 3 distinct groups: patients treated by PBT after an observation period (4/15), patients treated by PBT after primary surgery (5/15) and patients treated by PBT as primary treatment (6/15). Visual acuity improved in 3 cases, deteriorated in 1 and remained stable in 11 cases. Tumor size on MRI remained stable in 100 % of cases following PBT. No serious adverse effects were recorded after a mean follow-up of 22.4 months (8-79 months).
Our experience confirms the efficacy and the safety of proton beam therapy in patients with ONSM. PBT presents a promising alternative to surgery and conventional radiotherapy in the treatment of the MGNO. It seems to be effective in controlling tumor size and stabilizing visual function, at the cost of very low toxicity. Additional studies are needed to accurately determine the decision-making criteria and the ideal timing of this treatment.
视神经鞘膜瘤（ONSM）是一种常见的良性肿瘤，起源于包裹视神经的蛛网膜组织，主要影响中年女性。它是一种生长缓慢的肿瘤，目前在治疗方面仍未达成共识。
评估分次靶向质子束治疗（PBT）在治疗视神经鞘膜瘤中的安全性和有效性，并确定其在这些肿瘤治疗中的作用。
我们对2006年9月至2013年8月在巴黎阿道夫·德·罗斯柴尔德眼科基金会接受随访的15例原发性视神经鞘膜瘤患者（13名女性和2名男性，平均年龄41.8岁）进行了回顾性分析。经过多学科会诊后，所有患者均在巴黎居里研究所接受了总剂量为52.2 Gy等效钴（Eco）的PBT治疗，每次剂量为1.8 Gy Eco。患者每6个月接受包括眼科检查、视野测试和影像学检查在内的标准化随访。研究参数包括治疗后的视力、MRI上的肿瘤大小以及治疗副作用。
我们将患者分为3个不同的组：观察期后接受PBT治疗的患者（4/15）、初次手术后接受PBT治疗的患者（5/15）以及接受PBT作为初始治疗的患者（6/15）。3例患者视力改善，1例患者视力恶化，11例患者视力保持稳定。PBT治疗后，MRI上的肿瘤大小在100%的病例中保持稳定。平均随访22.4个月（8 - 79个月）后，未记录到严重不良反应。
我们的经验证实了质子束治疗对视神经鞘膜瘤患者的有效性和安全性。PBT在治疗视神经鞘膜瘤方面是一种有前景的替代手术和传统放疗的方法。它似乎能有效控制肿瘤大小并稳定视觉功能，且毒性极低。需要进一步研究以准确确定该治疗的决策标准和理想时机。
