• Marcello Marchetti, Stefania Bianchi, Valentina Pinzi, Irene Tramacere, Maria Luisa Fumagalli, Ida Maddalena Milanesi, Paolo Ferroli, Angelo Franzini, Marco Saini, Francesco DiMeco, and Laura Fariselli.
• *Radiotherapy Unit, Department of Neurosurgery,§Neuroepidemiology Unit,¶Health Department, and‖Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy;‡Neuroophthalmology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy.
• Neurosurgery. 2016 May 1; 78 (5): 638-46.

BackgroundConcern about radiation-induced optic neuropathy (RION) has governed recent thinking about the role of radiation therapy in the treatment of meningiomas involving the anterior optic pathways. Despite this concern, during the last few years, the use of radiosurgery for such lesions has increased steadily.ObjectiveTo define both the tumor control rate and the risk of RION over a long-term follow-up period in a large cohort of patients treated with multisession radiosurgery.MethodsThe local control and visual outcome of 143 patients who underwent multisession radiosurgery (mRS) were evaluated. Neurological outcome was also analyzed. The data for the present study were obtained from a prospectively maintained database.ResultsThe mean follow-up was 44 months (range, 12-113 months). All patients underwent mRS. The median prescription dose was 25 Gy delivered in 3 to 5 fractions. The prescription isodose, which typically encompassed at least 95% of the tumor, ranged from 65% to 86% (median, 80%). The mean tumor volume was 11.0 cm (range, 0.1-126.3 cm; median, 8 cm). The progression-free survival at 3, 5, and 8 years was 100%, 93%, and 90%, respectively. Compared with baseline, visual function improved in 36% of patients, whereas 7.4% experienced a worsening in visual function (5.1% excluding the patients with progressive disease).ConclusionGood local control rate and a low risk of RION indicate that mRS is a safe and effective treatment option in cases of large meningiomas.

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