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. 2014 Jan 17:9:27.
doi: 10.1186/1748-717X-9-27.

Neurosymptomatic carvenous sinus meningioma: a 15-years experience with fractionated stereotactic radiotherapy and radiosurgery

Sebastião Francisco Miranda Correa  1 , Gustavo Nader Marta, Manoel Jacobsen Teixeira
Affiliations

Neurosymptomatic carvenous sinus meningioma: a 15-years experience with fractionated stereotactic radiotherapy and radiosurgery

Sebastião Francisco Miranda Correa et al. Radiat Oncol. .

Abstract

Background: The tumor removal of Cavernous Sinus Meningiomas usually results in severe neurological deficits. Stereotactic radiosurgery (SRS) and fractionated Stereotactic radiotherapy (SRT) are advanced modalities of radiotherapy for treatment of patients with inoperable and symptomatic CSMs. The authors evaluated the long term symptomatology, the image findings, and the toxicity of patients with CSMs treated with SRS or SRT.

Patients and methods: From 1994 to 2009, 89 patients with symptomatic CSMs were treated with SRS or SRT. The indication was based on tumour volume and or proximity to the optic chiasm. The median single dose of SRS was 14 Gy, while the SRT total dose, ranged from 50.4 to 54 Gy fractionated in 1.8-2 Gy/dose. The median follow-up period lasted 73 months.

Results: The clinical and radiological improvement was the same despite the method of radiotherapy; 41.6% (SRS) and 48.3% (SRT) of patients treated. The disease-free survivals were 98.8%, 92.3% and 92.3%, in 5, 10, and 15 years, respectively. There was no statistical difference in relation to the symptoms and image findings between both methods. According to the Common Toxicity Criteria, 7% of the patients presented transient optic neuropathy during 3 months (grade 2) and recovered with dexamethasone, 2 patients had trigeminal neuropathy (grade 2) and improved rapidly, and one patient presented total occlusion of the internal carotid artery without neurological deficit (grade 2). Temporary lethargy and headache (grade 1) were the most frequent immediate complications. No severe complications occurred.

Conclusions: Stereotactic Radiosurgery and fractionated Stereotactic Radiotherapy were equally safe and effective in the management of symptomatic CSMs.

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Figures

Figure 1
Figure 1
MR images demonstrating radiological evolution in 10 years by STR treatment of patients with CV meningiomas. A: MRI for STR planning (1998); B: MRI after 5 years of the STR; C: MRI after 9 years of the STR.
Figure 2
Figure 2
Kaplan-Meier survival curve for the period of time of clinical improvement according to tumor volume of more than 14 cc or less than 14 cc.
Figure 3
Figure 3
Kaplan-Meier curves for progression-free survival.
See this image and copyright information in PMC

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