Preliminary Report of Multisession Gamma Knife Radiosurgery for Benign Perioptic Lesions: Visual Outcome in 22 Patients

  • Kim, Jong-Won (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Im, Yong-Seok (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Nam, Do-Hyun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Kwan (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jong-Hyun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung-Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2008.08.28

Abstract

Objective : Radiosurgery may be contraindicated for lesions adjacent to the optic pathways because of the substantial risk of visual complication. Multisession radiosurgery has been tried as a compromise between single session radiosurgery and fractionated radiotherapy. The purpose of this study is to evaluate the outcomes of multisession gamma knife radiosurgery (GKRS) in 22 patients with perioptic lesions of benign pathology. Methods : In all 22 cases, the lesions were within 1 mm of the optic apparatus and were therefore not considered suitable for single session radiosurgery. Radiation was delivered in 3 to 4 fractions with a median cumulated marginal dose of 20 Gy (range, 15-20 Gy). Results : During a mean follow-up of 29 months (range, 14-44 months), tumor control was achieved in 21 patients. Visual function improved in 7 patients, remained unchanged in 14 patients, and deteriorated in 1 patient with tumor progression. No other complication was observed. Conclusion : This preliminary result supports the idea that multisession GKRS may be an effective and safe alternative for treatment in perioptic lesions that are unsuitable for single session radiosurgery.

Keywords

References

  1. Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD : Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 59 : 244-254; discussion 244-254, 2006 https://doi.org/10.1227/01.NEU.0000223512.09115.3E
  2. Andrews DW, Suarez O, Goldman HW, Downes MB, Bednarz G, Corn BW, et al : Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50 : 1265-1278, 2001 https://doi.org/10.1016/S0360-3016(01)01559-0
  3. Cantore WA : Neural orbital tumors. Curr Opin Ophthalmol 11 : 367-371, 2000 https://doi.org/10.1097/00055735-200010000-00014
  4. Danesh-Meyer HV : Radiation-induced optic neuropathy. J Clin Neurosci 15 : 95-100, 2008 https://doi.org/10.1016/j.jocn.2007.09.004
  5. Kong DS, Lee JI, Lim do H, Kim KW, Shin HJ, Nam DH, et al : The efficacy of fractionated radiotherapy and stereotactic radiosurgery for pituitary adenomas: long-term results of 125 consecutive patients treated in a single institution. Cancer 110 : 854-860, 2007 https://doi.org/10.1002/cncr.22860
  6. Lunsford LD, Witt TC, Kondziolka D, Flickinger JC : Stereotactic radiosurgery of anterior skull base tumors. Clin Neurosurg 42 : 99-118, 1995
  7. Movsas B, Movsas TZ, Steinberg SM, Okunieff P : Long-term visual changes following pituitary irradiation. Int J Radiat Oncol Biol Phys 33 : 599-605, 1995 https://doi.org/10.1016/0360-3016(95)00221-J
  8. Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, et al : Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27 : 215-221, 1993 https://doi.org/10.1016/0360-3016(93)90230-S