Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Ribeirao Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.
Department of Image Sciences and Medical Physics, Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.
Radiother Oncol. 2021 Dec;165:135-141. doi: 10.1016/j.radonc.2021.10.009. Epub 2021 Oct 21.
The management of Optic Nerve Sheath Meningiomas (ONSM) has suffered a significant shift due to new radiation techniques. However, there is no conclusive information on which approach presents better results in the literature. This meta-analysis aims to evaluate the outcomes of different radiotherapy (RT) modalities in the management of ONSM.
A systematic review based on an electronic search was performed in MEDLINE, EMBASE, Cochrane, and Lilacs databases. Eligible studies included patients with ONSM treated with RT. Two reviewers independently assessed the eligibility of potential studies, extracted data, and performed the meta-analysis. Outcomes of interest were tumor control, visual acuity (VA), visual field, and complications.
Thirty-nine non-comparative studies involving 736 eyes with ONSM treated with RT were included. Six different techniques were studied: 2-dimensional RT (2DRT), 3D-conformal RT (3CRT), Stereotactic Fractionation RT (SFRT), stereotactic radiosurgery (SRS), intensity-modulated RT (IMRT), and proton beam therapy (PBT). With a mean follow-up period of 46 months, tumor control was 97,4% (95% CI: 98-100%). No difference was observed regarding the rate of final VA post-treatment among the modalities. The 3CRT showed substantially higher rates of complication than other techniques.
RT produces remarkable tumor control. New radiation modalities such as SFRT, IMRT, SRS, and PBT resulted in better therapeutic results with fewer complications than 2DRT and 3CRT. Thus, they should be the preferential choices for treating ONSM regardless of initial clinical presentation.
由于新的放射技术，视神经鞘脑膜瘤（ONSM）的治疗方法发生了重大转变。然而，文献中没有关于哪种方法能带来更好结果的确切信息。本荟萃分析旨在评估不同放射治疗（RT）方式在 ONSM 治疗中的结果。
对 MEDLINE、EMBASE、Cochrane 和 Lilacs 数据库进行了基于电子搜索的系统综述。纳入的研究包括接受 RT 治疗的 ONSM 患者。两名审查员独立评估潜在研究的纳入标准，提取数据并进行荟萃分析。感兴趣的结果是肿瘤控制、视力（VA）、视野和并发症。
纳入了 39 项非对照研究，共涉及 736 只接受 RT 治疗的 ONSM 眼。研究了六种不同的技术：二维放射治疗（2DRT）、三维适形放射治疗（3CRT）、立体定向分割放射治疗（SFRT）、立体定向放射外科（SRS）、强度调制放射治疗（IMRT）和质子束治疗（PBT）。在平均 46 个月的随访期间，肿瘤控制率为 97.4%（95%CI：98-100%）。在治疗后最终 VA 率方面，各治疗方法之间未见差异。3CRT 的并发症发生率明显高于其他技术。
RT 可显著控制肿瘤。SFRT、IMRT、SRS 和 PBT 等新的放射治疗方式比 2DRT 和 3CRT 具有更好的治疗效果，且并发症更少。因此，无论初始临床表现如何，它们都应成为治疗 ONSM 的首选方法。
