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Treatment options promising for optic nerve sheath meningioma
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CHICAGO — While there is still no ideal treatment for optic nerve sheath meningioma, recent advances in radiation therapy have provided promising outcomes that bode well for management of these tumors in the future, according to Neil R. Miller, MD.
“There have been major shifts in the paradigms for diagnosis and management,” said Dr. Miller, delivering the William F. Hoyt Lecture at the American Academy of Ophthalmology meeting here.
Observation is still appropriate for certain patients, Dr. Miller said, provided there is no significant visual dysfunction, progression of visual loss or intracranial extension of the tumor.
While in most cases some action is called for, surgery is rarely a feasible option, Dr. Miller said.
“(The disease) is usually not surgically curable unless it is accompanied by the removal of the optic nerve,” he said.
Surgery is indicated only in very specific circumstances, such as when excision of primarily exophytic tumors can be performed without visual loss.
Radiation therapy has become the preferred intervention for many specialists, but radiation is not without side effects, Dr. Miller said. For conventional fractionated radiation therapy, side effects include radiation retinopathy and radiation optic neuropathy.
“Are we giving too much radiation?” Dr. Miller asked. “If we could decrease the dose, we could reduce the risks and still eliminate the progression of the tumor.”
A relatively new option is stereotactic or three-dimensional conformal fractionated radiation therapy, which is more focused on the tumors because of the use of intensity-modulated beams, Dr. Miller said.
He noted that a number of reports have touted at least the short-term results of 3-D conformal fractionated radiation therapy.
Ideally, medical therapies will become available in the future that will avoid the side effects of radiation therapy, but nothing is available at the moment, Dr. Miller said.
“Right now there is no medical therapy as an alternative, but hopefully this will change,” he said. “There have been a tremendous number of advances in both the diagnosis and the treatment of optic nerve sheath meningiomas within the past several years, and hopefully we will see more in the future.”