This article is more than 5 years old. Information may no longer be current.
Radiation effective for sphenoid wing meningiomas, orbital surgeon says
Study finds no tumor recurrence, few complications in patients who received radiation.
Click Here to Manage Email Alerts
In the treatment of sphenoid wing meningiomas, many neurosurgeons have been taught to avoid radiation therapy because of the complications it creates for futures procedures.
But one orbital surgeon has suggested that that way of thinking may be wrong and that combining tumor excision with radiation therapy may prevent recurrence altogether, eliminating a second trip to the operating room.
Kimberly P. Cockerham, MD, who presented data on 69 patients treated with and without radiation for sphenoid wing meningiomas, noted that the tumor has a particularly high recurrence rate because of the difficulty in achieving total excision.
The tumor, which causes symptoms such as optic nerve compression, diplopia, proptosis and increased IOP, invades the cavernous sinus and the apex of the orbit. Its location typically prevents complete excision, and surgery places patients at risk for loss of function, permanent ptosis or ocular dysmotility.
The likelihood of reoperation, therefore, plays a significant role in treatment decisions, Dr. Cockerham noted. “It’s been taught that if patients are radiated, it makes them much more difficult to resect if [surgeons] have to go back in and do surgery,” she said.
|
|
|
| Surgery is considered for sphenoid wing meningiomas if there is disfiguring proptosis, progressive optic nerve dysfunction, symptomatic diplopia or documented growth. (Images courtesy of Kimberly P. Cockerham, MD.) | |
However, she told surgeons at the meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) to consider radiation not as a hindrance, but as a means of avoiding reoperation.
Study results
Dr. Cockerham and colleagues conducted a review of 69 patients treated for meningiomas between 1972 and 1999. She noted that while the study did not address resection after radiation, investigators instead found that none of the patients who underwent postoperative radiation therapy had recurrence during a mean 7.3-year follow-up.
Of 51 patients who underwent partial tumor excision without radiation, 65% experienced recurrence within a mean 4.3 years. In comparison, none of the 18 patients who underwent postoperative external beam radiation (45 Gy to 53 Gy) had recurrence, according to the study.
Patients received radiation about 2 months postoperatively to allow postsurgical edema to resolve.
“The main message is that ophthalmologists … need to be patient advocates and provide their patients information that radiation is safe and has been proven to delay recurrence or progression,” Dr. Cockerham said.
Complications
Investigators saw no secondary malignancies or radiation optic neuropathy in patients who received radiation. They reported one case of radiation retinopathy in a diabetic patient.
Radiation therapy may be contraindicated in children and teenagers because of the risk of hypothalamic dysfunction and in patients over 70 who are at risk for developing radiation necrosis or cognitive difficulties, according to Dr. Cockerham. Surgeons also tend to avoid radiating patients with severe vascular disease, she added.
Dr. Cockerham noted that most patients with sphenoid wing meningiomas are women between the ages of 30 and 50 who are otherwise healthy. “If patients with sphenoid wing meningiomas fall into the typical category (healthy and middle-age), they need to at least be made aware that [postoperative radiation] is an option,” she said. She added that improved radiation technology now allows more targeted treatment with less spread to surrounding tissues.
Common side effects include sunburn-like redness and dryness of the skin and a temporary dry eye state. Eyelash and eyebrow alopecia is possible but not typical, she said.
Uncommon practice
In an interview, Dr. Cockerham said that speaking with neurosurgeons about her findings has given her some idea of how uncommon it is for radiation to be administered postoperatively.
Before her presentation at the ASOPRS meeting, Dr. Cockerham said that she presented the results of her study to a group of 50 neurosurgeons during grand rounds. As an introduction, she offered the hypothetical case of a 40-year-old woman who undergoes excision of a sphenoid wing meningioma. A postoperative scan yields residual tumor in the apex.
Dr. Cockerham then asked the neurosurgeons whether they would offer radiation therapy at that point. Only two surgeons, she said, indicated in the affirmative. “That’s what’s frustrating because our study certainly isn’t providing any new information,” Dr. Cockerham told Ocular Surgery News. “It’s really just confirming old reports with a longer follow-up time.”
Ahead of progression
She added that most of the surgeons indicated that they typically do not recommend radiation until the tumor starts to show clinical progression or growth on neuroimaging. (In the hypothetical scenario, she asked the surgeons to assume that scans later revealed tumor growth at the 1-year follow-up, and nearly all opted for radiation.)
While radiation may not offer permanent remission, it might offer patients a decade or more without tumor progression, Dr. Cockerham said. And if radiation can prevent recurrence for a time period such as 15 years, then “you’ve provided the patient many years of excellent visual function without additional surgical interventions,” she said.
For Your Information:
- Kimberly P. Cockerham, MD, can be reached at Allegheny Ophthalmic and Orbital Associates, 420 East North Ave., Suite 116, Pittsburgh, PA 15212; 412-359-6300; fax: 412-359-6768; kpcorb@aol.com.