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


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.
Radiation Oncology Department - Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, CEP 01308-050 Sao Paulo, SP, Brazil. sf.correa@uol.com.br.
Sebastião Francisco Miranda
SF
Correa
Gustavo Nader
GN
Marta
Manoel Jacobsen
MJ
Teixeira
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden