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

Radiation Oncology

Manoel Jacobsen Teixeira³  Gustavo Nader Marta²  Sebastião Francisco Miranda Correa¹ 

[1] Radiation Oncology Department - Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, CEP 01308-050 Sao Paulo, SP, Brazil;Radiation Oncology Department Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, Brazil;Department of Neurology at the Medical School, University of São Paulo, São Paulo, SP, Brazil

关键词: Radiotherapy;    Fractionated stereotactic;    Radiosurgery;    Radiotherapy;    Meningioma;   

Others  :  814987
DOI  :  10.1186/1748-717X-9-27

 received in 2013-05-31, accepted in 2014-01-09,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Correa et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC: “Malignancy” in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 1999, 85:2046-2056.
• [2]Marta GN, Correa SF, Teixeira MJ: Meningioma: review of the literature with emphasis on the approach to radiotherapy. Expert Rev Anticancer Ther 2011, 11:1749-1758.
• [3]Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW: Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 2008, 79:574-580.
• [4]Smee RI, Williams JR, Schneider M, Meagher NS: Non-Surgical Management Of Meningiomas Involving The Cavernous Sinus. In Radiosurgery. Edited by McDermott MW. Basel: Karger; 2010:189-201.
• [5]Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M: Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 2002, 51:1153-1159.
• [6]Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD: Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 2002, 97:65-72.
• [7]Liscák R, Simonová G, Vymazal J, Janousková L, Vladyka V: Gamma Knife radiosurgery of meningiomas in the cavernous sinus region. Acta Neurochir (Wien) 1999, 141:473-480.
• [8]Steinvorth S, Welzel G, Fuss M, Debus J, Wildermuth S, Wannenmacher M, Wenz F: Neuropsychological outcome after fractionated stereotactic radiotherapy (FSRT) for base of skull meningiomas: a prospective 1-year follow-up. Radiother Oncol 2003, 69:177-182.
• [9]Debus J, Wuendrich M, Pirzkall A, Hoess A, Schlegel W, Zuna I, Engenhart- Cabillic R, Wannenmacher M: High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long term results. J Clin Oncol 2001, 19:3547-3553.
• [10]Litré CF, Colin P, Noudel R, Peruzzi P, Bazin A, Sherpereel B, Bernard MH, Rousseaux P: Fractionated stereotactic radiotherapy treatment of cavernous sinus meningiomas: a study of 100 cases. Int Radiat Oncol Biol Phys 2009, 4:1012-1017.
• [11]Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J: Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas: long-term experience and review of the literature. Strahlenther Onkol 2006, 182:635-640.
• [12]van Nieuwenhuizen D, Klein M, Stalpers LJ, Leenstra S, Heimans JJ, Reijneveld JC: Differential effect of surgery and radiotherapy on neurocognitive functioning and health-related quality of life in WHO grade I meningioma patients. J Neurooncol 2007, 84:271-278.
• [13]Dijkstra M, van Nieuwenhuizen D, Stalpers LJ, Wumkes M, Waagemans M, Vandertop WP, Heimans JJ, Leenstra S, Dirven CM, Reijneveld JC, Klein M: Late neurocognitive sequelae in patients with WHO grade I meningioma. J Neurol Neurosurg Psychiatry 2009, 80:910-915.