Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients

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OBJECTIVE

The authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).

METHODS

The authors retrospectively assessed treatment outcomes 5–18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22–83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm3 (range 0.1–37.3 cm3), and the median margin dose was 13.0 Gy (range 10–20 Gy).

RESULTS

Tumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8–120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438–12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041–0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3–85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm3) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026–12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS.

CONCLUSIONS

This long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.

ABBREVIATIONS ARE = adverse radiation effect; CN = cranial nerve; CSM = cavernous sinus meningioma; GKRS = Gamma Knife radiosurgery; PFS = progression-free survival; SRS = stereotactic radiosurgery.

Article Information

Correspondence Hideyuki Kano: University of Pittsburgh, PA. kanoh@upmc.edu.

INCLUDE WHEN CITING Published online July 20, 2018; DOI: 10.3171/2018.2.JNS172361.

Disclosures Dr. Lunsford is a consultant for and stockholder in Elekta AB as well as a consultant for DSMB and Insightec. This study was supported by an Elekta Research Grant.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flow diagram of the patient population and brief outcomes of GKRS. RTx = radiation therapy.

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    Kaplan-Meier curve of PFS with respect to tumors without prior operation (primary SRS) versus partially debulked tumors (adjuvant SRS) versus progressive tumors despite one or more prior surgeries (salvage SRS). Progressive tumors (salvage SRS) show shorter PFS (p = 0.034, compared with primary SRS; p = 0.014, compared with adjuvant SRS; both log-rank test). Values below the x-axis indicate the number of patients at each interval of the Kaplan-Meier analysis.

  • View in gallery

    Kaplan-Meier radiation-induced cranial neuropathy curves demonstrating the effect of tumor volume. Large tumors were more likely to develop permanent CN deficits (p = 0.052, log-rank test). Values below the x-axis indicate the number of patients at each interval of the Kaplan-Meier analysis.

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