title: Hypofractionated stereotactic radiotherapy for benign intracranial tumours of the cavernous sinus.
abstract: We present our experience with hypofractionated stereotactic radiotherapy (HSRT) using 15 fractions to treat benign conditions of the cavernous sinus (CS) and emphasise the outcome in terms of cranial nerve (CN) function and toxicity for long term safety and efficacy. We performed a retrospective review of prospectively collected data on 112 patients with benign tumours of the CS treated with HSRT between 1 January 1998 and 31 December 2009. While all tumours involved the CS, a separate analysis was undertaken for meningiomas and pituitary adenomas. The median follow-up was 77 months (range: 2.3-177). Fifty-seven patients (51%) had a diagnosis of meningioma and 55 (49%) had pituitary adenomas. Prior to HSRT, 82 patients (73%) underwent microsurgery. The median tumour volume was 6.6 cm(3) for meningiomas and 3.4 cm(3) for pituitary adenomas (interquartile range: 2.8-7.9), and the mean prescribed dose was 38 Gy (range: 37.5-40.0) to the tumour margin, delivered in 15 fractions. After HSRT, 57% of all preexisting cranial neuropathies either resolved or improved and 38% remained stable, whereas 5% deteriorated. The diagnosis of meningioma was the only variable associated with recovery of cranial neuropathy (p<0.001). Permanent CN complications occurred in three patients (3%). The 5 and 10 year actuarial freedom from progression for patients with meningiomas was 98% and 93%, respectively, and for patients with pituitary adenomas this was 96% and 96%, respectively. We demonstrate low rates of CN morbidity after HSRT and the possibility of resolution or improvement in CN function for common histologies involving the CS.
authors.affiliation: Radiation Oncology, Epworth Healthcare, Richmond, VIC 3121, Australia. Electronic address: neda.haghighi@epworth.org.au.
authors.forename: Neda
authors.initials: N
authors.lastname: Haghighi
authors.affiliation: William Buckland Radiotherapy Centre, The Alfred Hospital, Post Office Box 3150, Prahran, VIC 3181, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Seely
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Clinical Haematology, Alfred Hospital, Melbourne, Australia.
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.affiliation: Radiation Oncology, Epworth Healthcare, Richmond, VIC 3121, Australia; William Buckland Radiotherapy Centre, The Alfred Hospital, Post Office Box 3150, Prahran, VIC 3181, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Dally
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D002426:Cavernous Sinus / Q000601:surgery*; D003389:Cranial Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D020209:Cranial Nerve Injuries / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
keywords: Cavernous sinus; Hypofractionated; Meningioma; Pituitary adenoma; Stereotactic radiotherapy