Sasano Hiroyuki, Shikishima Keigo, Aoki Manabu, Sakai Tsutomu, Tsutsumi Yuki, Nakano Tadashi
Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan.
Graefes Arch Clin Exp Ophthalmol. 2019 Oct;257(10):2297-2306. doi: 10.1007/s00417-019-04424-w. Epub 2019 Aug 3.
The present study examined the efficacy and complications associated with intensity-modulated radiation therapy (IMRT) for optic nerve sheath meningioma (ONSM) in 15 cases and compared visual function before and after treatment.
Consecutively diagnosed patients with ONSM treated with IMRT were evaluated from 2012 to 2017. We categorized ONSM with three growth patterns (diffuse, fusiform, or globular). Visual acuity, visual fields, and optic disc findings were assessed before and after IMRT. Ocular and systemic complications were evaluated during and after treatment.
The 15 patients selected for analysis ranged in age from 33 to 77 years. Post-treatment observation periods were 8 to 57 months. After IMRT, tumor enlargement was not detected in any eyes, and tumor reduction was seen in 2 eyes. At final post-treatment follow-up, eyes with fusiform and globular growth maintained better visual acuity compared with pre-treatment, whereas 2 of 5 eyes with diffuse growth showed reduced vision. Five eyes with no apparent optic disc abnormality maintained better visual acuity compared with pre-treatment, whereas 8 of 10 eyes with disc edema and atrophy remained stable or showed reduced vision. Improvements were seen in all 5 eyes with optic discs negative for pre-treatment abnormalities. Final post-treatment visual field abnormalities improved in 11 eyes. All adverse events identified during IMRT improved rapidly during the treatment period.
IMRT for the treatment of ONSM achieved improvement and preserved visual function. In particular, early treatment with IMRT before the appearance of optic disc abnormalities can be more effective for improving visual function.
本研究探讨了15例视神经鞘膜瘤（ONSM）患者接受调强放射治疗（IMRT）的疗效及并发症，并比较了治疗前后的视功能。
对2012年至2017年连续诊断为ONSM并接受IMRT治疗的患者进行评估。我们将ONSM分为三种生长模式（弥漫性、梭形或球形）。在IMRT治疗前后评估视力、视野和视盘表现。在治疗期间和治疗后评估眼部和全身并发症。
入选分析的15例患者年龄在33至77岁之间。治疗后的观察期为8至57个月。IMRT治疗后，所有患眼均未检测到肿瘤增大，2只眼肿瘤缩小。在最终的治疗后随访中，梭形和球形生长的患眼与治疗前相比视力保持较好，而5只弥漫性生长的患眼中有2只视力下降。5只视盘无明显异常的患眼与治疗前相比视力保持较好，而10只视盘水肿和萎缩的患眼中有8只视力保持稳定或下降。治疗前视盘无异常的5只患眼视力均有改善。治疗后最终视野异常在11只眼中有所改善。IMRT治疗期间发现的所有不良事件在治疗期间均迅速改善。
IMRT治疗ONSM可改善并保留视功能。特别是在视盘异常出现之前早期进行IMRT治疗对视功能改善可能更有效。
