Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
Eye (Lond). 2024 Jan;38(1):89-94. doi: 10.1038/s41433-023-02640-7. Epub 2023 Jun 22.
Optic nerve sheath meningioma (ONSM) is a rare benign tumour that accounts for approximately 2% of all orbital tumours. Radiotherapy has gradually become an important treatment for ONSM because of its good effect in preserving or improving vision. We aimed to explore the effect of radiotherapy on tumour control and vision preservation/improvement in patients with ONSM.
Forty-three patients with primary ONSM treated in our institution from 2015 to 2021 were enrolled. The irradiation dose was from 50.4 to 54 Gy with 28-30 fractions. We evaluated the tumour volume on MRI or CT, and visual acuity before and after the radiotherapy.
Thirty-four patients (79%) experienced a vision decrease at diagnosis. The mean duration of follow-up was 54.1 months (ranges: 18-93, median: 56). Among 25 patients who had tumour evaluation using MRI, 16 patients (37.2%) showed stable tumours, 7 patients (16.3%) had tumour shrinkage, but 2 patients (4.7%) experienced tumour progression. Among the 39 patients performing vision acuity evaluation, 16 patients (37.2%) had vision improvement or recovery. 16 of the 23 patients without vision improvement demonstrated severe visual loss at diagnosis. Two patients had evidence of tumour progression during the follow-up. Additionally, 4 (10.2%) patients had dry eyes, 7 (17.9%) patients experienced watery eyes, and 3 (7.7%) patients had eye swelling. Patients with vision loss for more than 12 months had a lower possibility of vision recovery than those with vision loss for less than 12 months.
Radiotherapy such as IMRT, VMAT, and 3D-CRT plays an important role in the treatment of ONSM. The probability of vision recovery is lower in patients with severe vision loss at diagnosis or the duration of vision loss is more than 12 months.
视神经鞘脑膜瘤（ONSM）是一种罕见的良性肿瘤，约占所有眼眶肿瘤的 2%。由于在保留或改善视力方面效果良好，放射治疗已逐渐成为 ONSM 的重要治疗方法。我们旨在探讨放射治疗对视神经鞘脑膜瘤患者肿瘤控制和视力保留/改善的效果。
纳入 2015 年至 2021 年在我院治疗的 43 例原发性 ONSM 患者。照射剂量为 50.4 至 54Gy，共 28-30 个分次。我们评估了 MRI 或 CT 上的肿瘤体积以及放射治疗前后的视力。
34 例（79%）患者在诊断时出现视力下降。平均随访时间为 54.1 个月（范围：18-93，中位数：56）。在 25 例接受 MRI 肿瘤评估的患者中，16 例（37.2%）患者肿瘤稳定，7 例（16.3%）患者肿瘤缩小，但 2 例（4.7%）患者肿瘤进展。在 39 例进行视力评估的患者中，16 例（37.2%）患者视力改善或恢复。在 16 例没有视力改善的患者中，12 例患者在诊断时就已经出现严重的视力丧失。在随访期间，有 2 例患者出现肿瘤进展的证据。此外，4 例（10.2%）患者出现干眼，7 例（17.9%）患者出现流泪，3 例（7.7%）患者出现眼部肿胀。视力丧失时间超过 12 个月的患者比视力丧失时间少于 12 个月的患者视力恢复的可能性更低。
调强放疗（IMRT）、容积旋转调强放疗（VMAT）和三维适形放疗（3D-CRT）等放疗方法对视神经鞘脑膜瘤的治疗具有重要作用。在诊断时视力丧失严重或视力丧失时间超过 12 个月的患者，视力恢复的可能性较低。
