Single-fraction radiosurgery of benign cavernous sinus meningiomas

Clinical article

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Object

Stereotactic radiosurgery (SRS) is an important treatment option for patients with cavernous sinus meningiomas (CSM). To analyze factors associated with local tumor control and complications after single-fraction SRS, the authors reviewed cases involving patients treated with Gamma Knife SRS between 1990 and 2008.

Methods

Excluded were patients with WHO Grade II or III tumors, radiation-induced tumors, multiple meningiomas, neurofibromatosis Type 2, and prior or concurrent radiotherapy. Five patients were lost to follow-up and 3 patients refused research authorization. The remaining 115 patients (29 men, 86 women) had either histologically confirmed WHO Grade I (n = 46, 40%) or presumed (n = 69, 60%) CSM. The median treatment volume was 9.3 cm3 (range 1.3–42.2 cm3). The median margin dose was 16 Gy (range 12–20 Gy). The median follow-up after SRS was 89 months (range 12–251 months). Thirty-nine patients (34%) had 10 or more years of follow-up after SRS.

Results

Six patients (5%) had tumor progression (in field, n = 3; marginal, n = 3) at a median of 74 months (range 42–145 months) after SRS. The local tumor control rate was 99% at 5 years and 93% at 10 years after SRS. No analyzed factor was associated with local control after SRS. Fourteen patients (12%) had permanent complications at a median onset of 23 months (range 2–146 months) including trigeminal dysfunction (n = 9), diplopia (n = 2), ischemic stroke (n = 2), and hypopituitarism (n = 1). The 2-year, 5-year, and 10-year rates of complications were 7%, 10%, and 15%, respectively. Multivariate analysis found larger treatment volume (HR 1.1, 95% CI 1.02–1.2, p = 0.01) to be associated with complications after SRS. The complication rate for patients with a treatment volume of 9.3 cm3 or less was 3% (2 of 58 cases) compared with 21% (12 of 57 cases) for patients with a treatment volume greater than 9.4 cm3.

Conclusions

Single-fraction SRS at the radiation doses used in this series provided durable tumor control for patients with benign CSM. Larger tumor volume remains the primary factor associated with complications after single-fraction SRS of benign CSM despite advancements in SRS technique.

Abbreviations used in this paper:CSM = cavernous sinus meningioma; EBRT = external beam radiation therapy; LC = local tumor control; PIV = prescription isodose volume; RRC = radiation-related complications; SRS = stereotactic radiosurgery.

Article Information

Address correspondence to: Bruce E. Pollock, M.D., Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55905. email: pollock.bruce@mayo.edu.

Please include this information when citing this paper: published online June 28, 2013; DOI: 10.3171/2013.5.JNS13206.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graph showing local tumor control after single-fraction SRS of benign CSM. The dashed lines indicate 95% confidence intervals. The y axis indicates the percentage of patients with local tumor control; the x axis indicates time in months.

  • View in gallery

    Axial MR images obtained in a woman who presented with left-sided ptosis and diplopia and underwent SRS (PIV 35.5 cm3, tumor margin dose 14 Gy) at the age of 57 years. A: Post-gadolinium MR image obtained at the time of radiosurgery. B: Post-gadolinium MR image obtained 8 years after radiosurgery. The tumor has decreased in size but the patient's diplopia did not improve. C: Long-TR MR image obtained 12 years after radiosurgery showing a rostral pontine infarct.

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