Stereotactic radiotherapy using Novalis for skull base metastases developing with cranial nerve symptoms

Skull base metastatic tumors are rare. Breast cancer in particular can cause bone metastases after a long period of time. A 70-year-old woman presented with multiple cranial nerve palsy. Magnetic resonance imaging revealed a lesion that extended from the orbit to the base of the skull, and the patient was referred to our department. Ophthalmological evaluation showed left visual acuity impairment, left oculomotor nerve palsy, and left trochlear nerve palsy. Endoscopic biopsy performed 5 years after the completion of breast cancer treatment revealed skull base metastases. In unilateral multiple cranial nerve palsy, the possibility of skull base metastases should be considered.

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CRANIAL NERVE PALSIES DUE TO SKULL BASE METASTASES IN PATIENTS WITH PROSTATE CANCER: A REPORT OF TWO CASES

The Japanese Journal of Urology ◽

10.5980/jpnjurol1989.97.748 ◽

2006 ◽

Vol 97 (5) ◽

pp. 748-751

Author(s):

Masaki Kimura ◽

Takefumi Satoh ◽

Tetsuo Fujita ◽

Kazumasa Matsumoto ◽

Morihiro Nishi ◽

...

Keyword(s):

Prostate Cancer ◽

Skull Base ◽

Cranial Nerve ◽

Cranial Nerve Palsies ◽

Skull Base Metastases

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Fractionated External Beam Radiation Therapy for Skull Base Metastases With Cranial Nerve Involvement

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.07.1745 ◽

2015 ◽

Vol 93 (3) ◽

pp. E469

Author(s):

T. Onoe ◽

S. Kawashiro ◽

K. Sumita ◽

H. Ogawa ◽

H. Harada ◽

...

Keyword(s):

Radiation Therapy ◽

Skull Base ◽

Cranial Nerve ◽

External Beam Radiation Therapy ◽

External Beam Radiation ◽

External Beam ◽

Cranial Nerve Involvement ◽

Beam Radiation ◽

Nerve Involvement ◽

Skull Base Metastases

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Management of Cranial Nerve Injury Following Surgery of the Skull Base

Otolaryngologic Clinics of North America ◽

10.1016/s0030-6665(20)31944-7 ◽

1984 ◽

Vol 17 (3) ◽

pp. 577-589 ◽

Cited By ~ 1

Author(s):

Robert Thayer Sataloff ◽

Donald L. Myers ◽

Frederic B. Krenter

Keyword(s):

Skull Base ◽

Nerve Injury ◽

Cranial Nerve ◽

Cranial Nerve Injury

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Stereotactic radiotherapy for the treatment of acoustic neuromas

Journal of Neurosurgery ◽

10.3171/sup.2004.101.supplement3.0362 ◽

2004 ◽

Vol 101 (Supplement3) ◽

pp. 362-372 ◽

Cited By ~ 38

Author(s):

Michael T. Selch ◽

Alessandro Pedroso ◽

Steve P. Lee ◽

Timothy D. Solberg ◽

Nzhde Agazaryan ◽

...

Keyword(s):

Stereotactic Radiotherapy ◽

Tumor Size ◽

Cranial Nerve ◽

Target Volume ◽

Tumor Control ◽

Content Type ◽

Seventh Cranial Nerve ◽

Acoustic Neuromas ◽

Fine Print

Object. The authors sought to assess the safety and efficacy of stereotactic radiotherapy when using a linear accelerator equipped with a micromultileaf collimator for the treatment of patients with acoustic neuromas. Methods. Fifty patients harboring acoustic neuromas were treated with stereotactic radiotherapy between September 1997 and June 2003. Two patients were lost to follow-up review. Patient age ranged from 20 to 76 years (median 59 years), and none had neurofibromatosis. Forty-two patients had useful hearing prior to stereotactic radiotherapy. The fifth and seventh cranial nerve functions were normal in 44 and 46 patients, respectively. Tumor volume ranged from 0.3 to 19.25 ml (median 2.51 ml). The largest tumor dimension varied from 0.6 to 4 cm (median 2.2 cm). Treatment planning in all patients included computerized tomography and magnetic resonance image fusion and beam shaping by using a micromultileaf collimator. The planning target volume included the contrast-enhancing tumor mass and a margin of normal tissue varying from 1 to 3 mm (median 2 mm). All tumors were treated with 6-MV photons and received 54 Gy prescribed at the 90% isodose line encompassing the planning target volume. A sustained increase greater than 2 mm in any tumor dimension was defined as local relapse. The follow-up duration varied from 6 to 74 months (median 36 months). The local tumor control rate in the 48 patients available for follow up was 100%. Central tumor hypodensity occurred in 32 patients (67%) at a median of 6 months following stereotactic radiotherapy. In 12 patients (25%), tumor size increased 1 to 2 mm at a median of 6 months following stereotactic radiotherapy. Increased tumor size in six of these patients was transient. In 13 patients (27%), tumor size decreased 1 to 14 mm at a median of 6 months after treatment. Useful hearing was preserved in 39 patients (93%). New facial numbness occurred in one patient (2.2%) with normal fifth cranial nerve function prior to stereotactic radiotherapy. New facial palsy occurred in one patient (2.1%) with normal seventh cranial nerve function prior to treatment. No patient's pretreatment dysfunction of the fifth or seventh cranial nerve worsened after stereotactic radiotherapy. Tinnitus improved in six patients and worsened in two. Conclusions. Stereotactic radiotherapy using field shaping for the treatment of acoustic neuromas achieves high rates of tumor control and preservation of useful hearing. The technique produces low rates of damage to the fifth and seventh cranial nerves. Long-term follow-up studies are necessary to confirm these findings.

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Short diameter may be a useful simple indicator of the tumor response in skull base meningiomas after conventionally fractionated stereotactic radiotherapy

European Radiology ◽

10.1007/s00330-021-07707-1 ◽

2021 ◽

Author(s):

Keiichi Takehana ◽

Daisuke Nakamura ◽

Alshaymaa Abdelghaffar ◽

Megumi Uto ◽

Tomohiro Katagiri ◽

...

Keyword(s):

Skull Base ◽

Stereotactic Radiotherapy ◽

Tumor Volume ◽

Tumor Response ◽

Fractionated Stereotactic Radiotherapy ◽

Skull Base Meningioma ◽

Skull Base Meningiomas ◽

Simple Indicator ◽

Conventionally Fractionated

Abstract Objectives The purpose of this study was to assess the radiological change patterns in skull base meningiomas after conventionally fractionated stereotactic radiotherapy (CFSRT) to determine a simple and valid method to assess the tumor response. Materials and methods Forty-one patients with a benign skull base meningioma treated by CFSRT from March 2007 to August 2015 were retrospectively evaluated. We measured tumor volume (TV), long-axis diameter (LD), and short-axis diameter (SD) on both pre-treatment images and follow-up images of 1, 3, and 5 years after CFSRT, respectively. The paired t test was used to detect differences in the LD and SD change rates. Spearman’s correlation coefficients were calculated to evaluate relationships between the TV and the diameters changes. Results The number of available follow-up MRIs that was performed at 1, 3, and 5 years after the CFSRT was 41 (100%), 34 (83%), and 23 (56%), respectively. The change rates of SD were significantly higher than those of LD at every time point and more strongly correlated with the change rates of tumor volume at 3 and 5 years after CFSRT. Conclusions SD may be useful as a simple indicator of the tumor response for skull base meningioma after CFSRT. Key Points • The change rate in short-axis diameter is a useful and simple indicator of the response of skull base meningioma to conventionally fractionated stereotactic radiotherapy. • Conventionally fractionated stereotactic radiotherapy for skull base meningioma achieved excellent 5-year local control.

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