Fractionated Conformal Radiotherapy in the Management of Cavernous Sinus Meningiomas: Long-Term Functional Outcome and Tumor Control at a Single Institution

Abstract

To evaluate long-term outcome of cavernous sinus meningioma (CSM) treated with fractionated conformal radiotherapy (FCR). Fifty-three patients with CSMs (16 men [30.2%], 37 women [69.8%], aged 53 ± 13.0 years [mean ± SD]) were treated by FCR. In 28 patients (52.8%) FCR was performed as first-line treatment and in 25 patients (47.2%) as adjuvant treatment. All patients received FCR with a dose of 52.9 ± 1.8 Gy in 29.4 ± 1.0 fractions over 6 weeks. Dose per fraction was 1.9 ± 0.1 Gy. Radiotherapy was delivered stereotactically in 47 cases (88.7%) and conformally in 6 (11.3%) The median follow-up was 6.9 years (range, 3-19 years). According to Sekhar's classification, 19 patients (35.8%) were Grade 1-2, 30 patients (56.6%) were Grade 3-4, and 4 patients (7.6%) were Grade 5. Pretreatment tumor volume was determined in 46 patients, and tumor volume was 12.6 ± 8.2 cm(3). In these patients, the distance between tumor and optic apparatus was 1.62 ± 1.2 mm. Actuarial 5- and 10-year progression-free survival rates were 98.1% and 95.8%, respectively. Clinical improvement was observed in 31 patients (58.5%), and 20 patients (37.7%) remained unchanged. Radiologic response was observed in 18 patients (30.2%), and 35 patients (66.0%) showed stable lesions. Two patients (3.8%) showed tumor progression during follow-up. Transient morbidity was observed in 3 patients (5.7%) and permanent morbidity in 1 (1.9%). Fractionated conformal radiotherapy affords satisfactory long-term tumor control and low treatment morbidity.