Combined helical tomotherapy and Gamma Knife stereotactic radiosurgery for high-grade recurrent orbital meningioma: a case report

Frontiers in Oncology

Oncology

Hanfeng Wu¹  Haomiao Zhang²  Lili Yu²  Jianjie Lu³  Wencheng Shao³ 

[1] Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China;Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China;Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, China;

关键词: orbital meningioma;    anaplastic meningioma;    surgery;    radiation therapy;    stereotactic radiosurgery;    Gamma Knife;   

DOI  :  10.3389/fonc.2023.1273465

 received in 2023-08-06, accepted in 2023-09-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

Orbital meningioma is a rare type of orbital tumor with high invasiveness and recurrence rates, making it extremely challenging to treat. Due to the special location of the disease, surgery often cannot completely remove the tumor, requiring postoperative radiation therapy. Here, we report a case of an elderly male patient with right-sided proptosis, visual impairment, and diplopia. Imaging diagnosis revealed a space-occupying lesion in the extraconal space of the right orbit. Pathological and immunohistochemical examination of the resected tumor confirmed it as a grade 3 anaplastic meningioma. Two months after surgery, the patient complained of right eye swelling and a magnetic resonance imaging (MRI) scan showed a recurrence of the tumor. The patient received helical tomotherapy (TOMO) in the postoperative tumor bed and high-risk areas within the orbit with a total dose of 48Gy. However, there was no significant improvement in the patient’s right eye swelling, and the size of the recurrent lesion showed no significant change on imaging. Gamma knife multifractionated stereotactic radiosurgery (MF-SRS) was then given to the recurrent lesion with 50% prescription dose 13.5Gy/3f, once every other day. An imaging diagnosis performed 45 days later showed that the tumor had disappeared completely. The patient’s vision remained unchanged, but diplopia was significantly relieved after MF-SRS. We propose a new hybrid treatment model for recurrent orbital meningioma, where conventional radiation therapy ensures local control of high-risk areas around the postoperative cavity, and MF-SRS maximizes the radiation dose to recurrent lesion areas while protecting surrounding tissues and organs.

【 授权许可】

Unknown   
Copyright © 2023 Zhang, Wu, Lu, Shao and Yu