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Comparative Study
. 2025 Jun;173(2):331-341.
doi: 10.1007/s11060-025-04986-2. Epub 2025 Mar 11.

Gamma Knife Radiosurgery for optic nerve sheath meningioma: comparison of efficacy and costs with radiotherapy under Korean health insurance system

Shang-Te Ma  1   2 , Yong Chan Ahn  3 , Do Hoon Lim  3 , Jung-Il Lee  4 , Ho Jun Seol  4 , Won-Jae Lee  4 , Yong Seok Im  4 , Kyung-Ah Park  5 , Yoon-Duck Kim  6 , Kyung In Woo  7
Affiliations
Comparative Study

Gamma Knife Radiosurgery for optic nerve sheath meningioma: comparison of efficacy and costs with radiotherapy under Korean health insurance system

Shang-Te Ma et al. J Neurooncol. 2025 Jun.

Abstract

Purpose: To survey the real-world effectiveness and cost of optic nerve sheath meningioma (ONSM) treating with Gamma Knife Radiosurgery (GKRS), and compare with the external beam radiation therapy (EBRT).

Methods: Retrospective, comparative study that included patients with primary ONSM treated with either GKRS or EBRT in Samsung Medical Center, Korea. The treatment response, and treatment costs were compared between GKRS and EBRT groups.

Results: There were 34 adult patients with primary ONSM treated with either GKRS (n = 25) or EBRT (n = 9) (follow-up period: 6-207 months). The local tumor control rates (GKRS: 92%; EBRT: 100%; P = 1) and vision preservation rates (GKRS: 64%; EBRT: 67%; P = 1) were similar in both groups. The mean gross tumor volume (GTV) decreased by 21.4 ± 19.7% after GKRS and 26.4 ± 18.7% after EBRT (P = 0.4803). The complication rates did not differ between two modalities. Factors associated with better visual outcomes were pretreatment BCVA > 20/50 (odds ratio: 6.000, P = 0.0234) and the absence of intracranial tumor extension (odds ratio: 30.00, P = 0.0001). GKRS reduced the total costs of care by 43% under Korean National Health Insurance System (NHIS).

Conclusion: This study revealed that GKRS and EBRT had similar treatment efficacy and safety profile in treating ONSMs. Instant management is advantageous when the BCVA deteriorates to 20/50 and tumors involve intracranially. Under the framework of Korean NHIS, GKRS contributed to less indirect cost estimates and was preferred by patients under shared decision-making process.

Keywords: Direct medical cost; Gamma Knife Radiosurgery; Indirect cost estimates; Optic nerve sheath meningioma.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Images from a 54-year-old woman with high myopia presenting with right eye proptosis and gradual, painless vision loss who underwent four-session Gamma Knife radiosurgery (GKRS) for optic nerve sheath meningiomas (ONSM). (A) GKRS dosimetry. (B) Pre-GKRS shows a diffuse type ONSM on magnetic resonance imaging, optic disc swelling, and deteriorated best-corrected visual acuity (BCVA; 20/40) and visual field index (VFI; 73%) in Humphrey visual field. (C) Sixty months after GKRS, 26.9% shrinkage of the gross tumor volume (GTV), resolution of disc swelling, and BCVA (20/20) and VFI (90%) recovery are observed
Fig. 2
Fig. 2
Images from a 40-year-old woman presenting with left eye proptosis and vision loss who received intensity-modulated radiotherapy (IMRT) for optic nerve sheath meningiomas (ONSM). (A) IMRT dosimetry. (B) Pre-radiotherapy showed a posterior type ONSM on magnetic resonance imaging, optic disc swelling, and deteriorated best-corrected visual acuity (BCVA; 20/30) and visual field index (VFI; 94%) in Humphrey visual field. (C) Twenty-four months after IMRT, 29.9% shrinkage of the gross tumor volume (GTV), resolution of disc swelling, and near total BCVA (20/20) and VFI (100%) recovery are observed
See this image and copyright information in PMC

References

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