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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 94305, USA. jra@stanford.edu
Neurosurgery
|September 16, 2008
Summary
Multisession radiosurgery effectively controls perioptic tumors and preserves vision. This study in 49 patients shows high tumor control and visual function preservation, supporting its use 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 with small patient numbers and short 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, average tumor volume 7.7 cm³, cumulative dose 20.3 Gy, with regular visual and imaging follow-up.
Main Results:
- After a mean follow-up of 49 months, 94% of patients retained or improved vision (38 unchanged, 8 improved).
- Three patients experienced visual deterioration linked to tumor progression and death.
- Tumor volume remained stable or decreased in all other patients after a mean MRI follow-up of 46 months.
Conclusions:
- Multisession radiosurgery achieves high tumor control rates and preserves visual function in patients with perioptic tumors.
- This approach is a safe and effective alternative to surgery or fractionated radiotherapy for selected lesions adjacent to the optic apparatus.
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