title: Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy.
abstract: OBJECTIVE
  To investigate the respective role of fractionated radiotherapy (FR) and gamma knife stereotactic (GKS) radiosurgery in cavernous sinus meningioma (CSM) treatment.
  
  
  METHODS
  The authors report the long-term follow-up of two populations of patients harboring CSMs treated either by FR (Group I, 38 patients) or GKS radiosurgery (Group II, 36 patients). There were 31 females with a mean age of 53 years in Group I and 29 females with a mean age of 51.2 years in Group II. In 20 patients (Group I) and 13 patients (Group II), FR and GKS radiosurgery were performed as an adjuvant treatment. In 18 patients (Group I) and in 23 patients (Group II), FR and GKS radiosurgery were performed as first line treatment. In our early experience with GKS radiosurgery (1992, date of gamma knife availability in the department), patients with tumors greater than 3 cm, showing close relationship with the optic apparatus (<3 mm) or skull base dural spreading, were treated by FR. Secondarily, with the advent of new devices and our growing experience, these criteria have evolved.
  
  
  RESULTS
  The median follow-up period was 88.6 months (range, 42-168 mo) for Group I and 63.6 months (range, 48-92 mo) for Group II. According to Sekhar's classification, 26 (68.4%) patients were Grade III to IV in Group I and 10 (27.8%) patients in Group II (P < 0.05); 23 (60.5%) patients had extensive lesions in Group I and 7 (19.4%) patients in Group II (P < 0.05). Mean tumor volume was 13.5 cm in Group I and 5.2 cm in Group II (P < 0.05). Actuarial progression-free survival was 94.7% and 94.4% in Group I and II, respectively. Clinically, improvement was seen for 24 (63.2%) patients in Group I and for 21 (53.8%) patients in Group II (P > 0.05). Radiologically, 11 (29%, Group I) patients and 19 (Group II, 52.7%) patients showed tumor shrinkage (P = 0.04). Transient morbidity was 10.5% in Group I and 2.8% in Group II. Permanent morbidity was 2.6% in Group I and 0% in Group II.
  
  
  CONCLUSIONS
  FR and GKS radiosurgery are safe and efficient techniques in treatment of CSMs, affording comparable satisfactory long-term tumor control. However, GKS radiosurgery provides better radiological response, is far more convenient, and fits into most patients lives much better than FR. Therefore, in the authors' opinion, GKS radiosurgery should be advocated in first intention for patients with CSMs, whereas conventional radiotherapy should be reserved for cases that are not amenable to this technique, thus making these two therapeutic modalities not alternative but complementary tools in CS meningioma treatment strategy.
authors.affiliation: Department of Neurosurgery, Timone Hospital, University of Aix-Marseille II, Marseille, France. philippe.metellus@mail.aphm.fr
authors.forename: Philipe
authors.initials: P
authors.lastname: Metellus
authors.forename: Jean
authors.initials: J
authors.lastname: Regis
authors.forename: Xavier
authors.initials: X
authors.lastname: Muracciole
authors.forename: Stephane
authors.initials: S
authors.lastname: Fuentes
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nanni
authors.forename: Oliver
authors.initials: O
authors.lastname: Chinot
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Martin
authors.forename: Francois
authors.initials: F
authors.lastname: Grisoli
mesh_terms: D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods; D016634:Radiosurgery; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome