Abstract
Purpose: Surgical resection has been traditionally used as a treatment for cavernous sinus hemangioma (CSH). However, this is usually difficult due to tumor vascularity and results in complications especially in large and giant CSH (volume >20 cm3). Previous studies have reported that radiotherapy (RT) provides an alternative treatment modality for hemangiomas. However, the optimized dose and fractions which control CSH and also protect the cognitive function remain unclear. This study reports our experience in the management of symptomatic large and giant CSH.Methods: Fifty-four patients with symptomatic large (20 cm3 <tumor volume ≤ 40 cm3, 3–4 cm in diameter) and giant (tumor volume>40 cm3, >4 cm in diameter) CSH were enrolled in a retrospective study between January 2007 and December 2018. The prescription dose to the target margin was 50 Gy in 25 fractions.Results: The mean pre-RT tumor volume was 60.9 cm3 which ranged from 20.2 to 230.5 cm3. The clinical data obtained was analyzed retrospectively following a mean follow-up period of 35.0 months which ranged from 1 to 140 months. All patients experienced tumor shrinkage within 3 months after radiotherapy. There was an average mean tumor reduction of 79.7% (range, 48.4–98.5%) with no patients experiencing tumor progression and recurrence. All the 54 patients experienced symptomatic improvement within 1 month to 12 months after radiotherapy. Within the entire follow up period, no patients experienced any form of permanent complications or symptomatic radiation toxicity. Neurocognitive impairment studies were conducted before and after radiotherapy on 28 patients while the studies were conducted after the last follow up in 40 patients. The cognitive function of all the participants had normal MoCA-scores of 28.25 pre-radiotherapy. The post-treatment MoCA-scores were also clinically stable (28.04, p = 0.78), and the average MoCA-score did not show any decline until the last follow-up (27.61, p = 0.13).Conclusion: The optimal dose and fractions of radiotherapy treatment for symptomatic large and giant cavernous sinus hemangioma remain unclear. This study, therefore, used a marginal dose of 50 Gy in 25 fractions in radiotherapy and this was proven to be effective and relatively safe in the treatment of symptomatic large and giant CSHs.
Highlights
Hemangioma is a benign vascular tumor which causes clinical symptoms due to its progressive tumor growth and large size [1]
A brain magnetic resonance imaging (MRI) and/or computed tomography (CT) study was used as the primary diagnostic tool in all the patients
A total of 5 patients were pathologically diagnosed, while 49 patients were diagnosed through MRI with or without digital subtraction angiography (DSA)
Summary
Hemangioma is a benign vascular tumor which causes clinical symptoms due to its progressive tumor growth and large size [1]. The fatality rate in the case of a rupture or bleeding is extremely high For this type of benign tumor, treatment can be achieved through the complete removal of CSH. The resection of large and giant CSHs is challenging due to the complex natural anatomic structures around the tumor [6]. Surgical management of this lesion is associated with extremely high risks due to the possibilities of significant blood loss and cranial neuropathies, it is difficult to achieve total resection. Despite the recent advances in neurosurgical techniques, the total resection rate of CSHs by surgical excision is 64%, and cranial neuropathies-related symptoms deteriorate after surgical treatment in ∼71% of the patients [7, 8]
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