Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance

Brell, Marta; Villà, Salvador; Teixidor, Pilar; Lucas, Anna; Ferrán, Enric; Marín, Susanna; Acebes, Juan Jose

doi:10.1016/j.surneu.2005.06.027

« Previous Next »Surgical Neurology
Volume 65, Issue 1 , Pages 28-33, January 2006

Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance

This paper was presented as oral presentation at the 6th European Skull Base Society Congress, Terrassa, Barcelona, Spain on March 6 to 8, 2003.

Marta Brell, MD
- Neurosurgery Department, Hospital Universitàri de Bellvitge, L'Hospitalet, Barcelona, Spain 08907
- Corresponding author. Servicio de Neurocirugía. Hospital Universitàri de Bellvitge, Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Salvador Villà, PhD
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Universitàri de Bellvitge, L'Hospitalet, Barcelona, Spain 08907
Pilar Teixidor, MD
- Neurosurgery Department, Hospital Universitàri de Bellvitge, L'Hospitalet, Barcelona, Spain 08907
Anna Lucas, MD
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Universitàri de Bellvitge, L'Hospitalet, Barcelona, Spain 08907
Enric Ferrán, MD
- Neurosurgery Department, Hospital Universitàri de Bellvitge, L'Hospitalet, Barcelona, Spain 08907
Susanna Marín, PhD
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Universitàri de Bellvitge, L'Hospitalet, Barcelona, Spain 08907
Juan Jose Acebes, PhD
- Neurosurgery Department, Hospital Universitàri de Bellvitge, L'Hospitalet, Barcelona, Spain 08907

Received 28 October 2004; accepted 6 June 2005.

Abstract

Background

Fractionated stereotactic radiotherapy (FSRT) combines the precision of stereotactic positioning with the radiobiologic advantage of dose fractionation.

Methods

From June 1997 to June 2001, 30 patients with cavernous sinus meningiomas were treated with FSRT using fixed noncoplanar conformal fields. Patient skull fixation was achieved using the BrainLAB mask (20 patients) or Beverly frame (10 patients). The Cosman-Roberts-Wells coordinate frame was used for stereotactic space definition. In selected cases before 1999, and in all cases afterward, gadolinium-enhanced MRI for image fusion was performed. The median radiation dose was 52 Gy, with a daily fraction of 2 Gy. Patients were regularly followed up analyzing symptoms, tumor progression, and side effects. Neurocognitive function was evaluated retrospectively for 26 patients using Mini-Mental State Examination.

Results

Median follow-up period was 50 months (range, 28.2-74.5 months). Preexisting neurologic symptoms improved in 50% of the patients and worsened in 2 patients. Only 2 patients progressed and the actuarial local progression free survival was 93% at 4 years. Tolerance was good with 2 cases of late radiation toxicity which consisted of moderate short-term memory loss and dysphasia in one case and neuropsychologic deficit with seizures in the other. Postradiotherapy Mini-Mental State Examination results showed a median score of 28 (range, 16-30).

Conclusions

Fractionated stereotactic radiotherapy is a high-precision technique. It is safe and feasible in the primary and adjuvant treatment of cavernous sinus meningiomas. Fractionated stereotactic radiotherapy allowed local control in more than 90% of patients.

Abbreviations: CT, Computed tomography, FSRT, Fractionated stereotactic radiotherapy, GTV, Gross total volume, KPS, Karnofsky performance status, MRI, Magnetic resonance imaging, OR (95% CI), Odds ratio (95% confidence interval), PTV, Planning target volume, WHO, World Health Organization