Long-term outcome in orbital meningiomas: progression-free survival after targeted resection combined with early or postponed postoperative radiotherapy

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  • 1 Departments of Neurosurgery,
  • 2 Radiation Oncology,
  • 3 Ophthalmology, and
  • 4 Neuropathology, University Hospital, LMU Munich;
  • 5 European Cyberknife Center, Munich; and
  • 6 German Cancer Consortium (DKTK), partner site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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OBJECTIVE

In meningiomas involving the orbit and optic canal, surgery is the mainstay of therapy. However, radical resection is often limited to avoid functional damage, so multidisciplinary treatment concepts are implemented. Data on the timing and value of early postoperative radiotherapy (PORT) are scarce. This retrospective study analyzes outcomes in patients who underwent targeted resection alone or in combination with early PORT.

METHODS

Patients undergoing resection of orbit-associated WHO grade I meningiomas from January 1999 to December 2013 who presented to the authors’ department at least twice for follow-up were included. Clinical and radiological findings were analyzed retrospectively. Patients were stratified into two cohorts: follow-up with MRI scans at regular intervals, i.e., the watch and wait (W&W) group, and a PORT group receiving PORT within 6 months after surgery in addition to MRI follow-up. Patients in the W&W group were scheduled for treatment when tumor progression was detected by imaging.

RESULTS

One hundred twenty-two patients were included. The mean follow-up was 70 months. The most common symptoms at presentation were visual disturbances; 87.7% of patients received Simpson grade II–III targeted partial resection. Twenty-three patients received PORT, and 99 patients were regularly observed with MRI scans (W&W group). Tumor recurrence/progression occurred significantly later (76.3 vs 40.7 months) and less frequently in the PORT group (13%) than in the W&W group (46.5%). Cases of recurrence were diagnosed an average of 39 months after initial surgery in both groups. PORT patients demonstrated significantly less visual impairment at last follow-up.

CONCLUSIONS

These results indicate that receiving PORT early after targeted partial resection might help to postpone tumor recurrence and the need for additional treatment, while preserving or even improving visual outcome.

ABBREVIATIONS CN = cranial nerve; EBRT = external beam radiation therapy; PFS = progression-free survival; PORT = postoperative radiotherapy; W&W = watch and wait.

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Contributor Notes

Correspondence Nicole Angela Terpolilli: University Hospital, LMU Munich, Germany. nicole.terpolilli@med.uni-muenchen.de.

INCLUDE WHEN CITING Published online June 14, 2019; DOI: 10.3171/2019.3.JNS181760.

Disclosures Dr. Tonn reports being a consultant for BrainLAB.

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