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Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions
John R Adler1, Iris C Gibbs, Putipun Puataweepong
1Department of Neurosurgery, Stanford University Medical School, Stanford, California, USA. jra@stanford.edu
Neurosurgery
|August 3, 2006
Summary
Multisession radiosurgery effectively controlled perioptic tumors and preserved vision in most patients. This approach offers a safe alternative to surgery or conventional radiotherapy for tumors near the optic apparatus.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Ophthalmology
Background:
- Anterior visual pathways have limited radiation tolerance, complicating treatment of adjacent lesions with single-session radiosurgery.
- Preliminary studies suggest multisession radiosurgery is safe and effective for perioptic tumors, but require larger patient cohorts and longer follow-up.
Purpose of the Study:
- To evaluate the safety and efficacy of multisession radiosurgery for perioptic tumors.
- To address limitations of previous studies regarding patient numbers and follow-up duration.
Main Methods:
- Retrospective study of 49 patients with perioptic tumors (meningioma, pituitary adenoma, etc.) treated with multisession image-guided radiosurgery (CyberKnife).
- Tumors were located within 2 mm of the optic apparatus; 39 patients had prior surgery, 6 had prior radiotherapy.
- Treatment involved 2-5 sessions to an average volume of 7.7 cm³ with a cumulative dose of 20.3 Gy, followed by regular visual and imaging assessments.
Main Results:
- After a mean follow-up of 49 months, 94% of patients maintained or improved vision.
- Tumor volume remained stable or decreased in all patients except three who experienced progression and died.
- One patient with recurrent pituitary adenoma had initial vision loss without significant tumor progression.
Conclusions:
- Multisession radiosurgery achieves high tumor control rates and preserves visual function in perioptic tumors.
- This intermediate-term data supports multisession radiosurgery as a safe and effective alternative for selected lesions adjacent to the optic apparatus.
