Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
World Neurosurg. 2022 Aug;164:e929-e944. doi: 10.1016/j.wneu.2022.05.064. Epub 2022 May 21.
Optic nerve sheath meningiomas (ONMs) are often managed with radiotherapy (RT) with the goal of achieving radiographic local control (LC) and preventing deterioration of visual acuity (VA). We aimed to perform a systematic review and meta-analysis of outcomes for patients with ONM treated with RT.
The PICOS/PRISMA/MOOSE selection criteria were used to identify studies. Primary outcomes were stable or improved VA and radiographic LC at last follow-up. The secondary outcomes were incidences of radiation-induced retinopathy and xerophthalmia and stable or improved visual fields (VFs). Weighted random-effects meta-analyses using the DerSimonian and Laird methods were conducted to characterize effect sizes. Mixed-effects regression models were used to examine potential correlations between gross tumor volume (GTV) and outcomes.
In total, 444 patients with ONM across 20 published studies were included. The estimated LC rate was 99.8% (95% confidence interval [CI], 98.3%-100%), and the estimated proportion of patients with stable or improved VA or VF was 89.7% (95% CI, 86.2%-92.4%) and 93.3% (95% CI, 89.5%-95.8%), respectively. Estimated incidences of radiation-induced retinopathy and xerophthalmia were 7.2% and 10.1%, respectively. GTV was significantly associated with VA (P = 0.014) with estimated VA rates of 96.4%, 91.4%, and 80.5% for GTVs of 2.0, 3.0, and 4.0 cm, respectively.
RT was well tolerated, with excellent LC achieved. Nearly 90% of patients noted either stability or improvement in VA and VF. Larger ONMs were associated with poorer VA.
视神经鞘脑膜瘤（ONM）通常采用放疗（RT）治疗，目的是实现影像学局部控制（LC）和防止视力（VA）恶化。我们旨在对接受 RT 治疗的 ONM 患者的结果进行系统评价和荟萃分析。
采用 PICOS/PRISMA/MOOSE 选择标准来确定研究。主要结局是最后一次随访时 VA 稳定或改善以及影像学 LC。次要结局是放射性视网膜病变和干眼症的发生率以及视野（VF）稳定或改善。使用 DerSimonian 和 Laird 方法进行加权随机效应荟萃分析以描述效应大小。使用混合效应回归模型来研究肿瘤总体积（GTV）与结局之间的潜在相关性。
共有 20 项已发表研究的 444 名 ONM 患者被纳入。LC 率估计为 99.8%（95%置信区间 [CI]，98.3%-100%），VA 稳定或改善或 VF 稳定或改善的患者比例估计分别为 89.7%（95% CI，86.2%-92.4%）和 93.3%（95% CI，89.5%-95.8%）。放射性视网膜病变和干眼症的估计发生率分别为 7.2%和 10.1%。GTV 与 VA 显著相关（P=0.014），GTV 分别为 2.0、3.0 和 4.0 cm 时，VA 估计率分别为 96.4%、91.4%和 80.5%。
RT 耐受良好，实现了极佳的 LC。近 90%的患者 VA 和 VF 稳定或改善。较大的 ONM 与较差的 VA 相关。
