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

Métellus, Philippe; Batra, Sachin; Karkar, Siddharth; Kapoor, Sumit; Weiss, Stéphanie; Kleinberg, Lawrence; Rigamonti, D.

doi:10.1016/j.ijrobp.2009.08.006

Cited by 49 publications

(39 citation statements)

References 45 publications

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“…Our visual outcome data compare somewhat unfavorably with earlier series of tumors of the anterior skull base region treated with FSRT, with several studies reporting a low 0–6 % incidence of visual loss for meningiomas around the anterior visual pathways [3, 14–20] and similarly for pituitary adenomas, in the range 0–9 % [2, 21–29]. However, direct comparison with these previous studies is difficult, since median follow-up for most of them was significantly shorter [2, 3, 15, 16, 19, 20, 22, 24–27, 29] and several included a number of patients with less than 2 years follow up [2, 16, 20, 22, 24, 26, 27, 29, 30].…”

Section: Discussionsupporting

confidence: 78%

“…The 5 year tumor control rate of 88.4 % for the anterior skull base meningiomas did not differ significantly from that of other FSRT series reporting a tumor control rate of 88–98 % [14, 16, 30, 32, 35, 36] and the 5 year tumor control rate for the pituitary adenomas of 98.2 %, compared favorably with the rates of 93–99 % reported in other FSRT series [21–24, 27]. Furthermore, although tumors close to the visual pathways treated with FSRT tend to be larger, our 5 syear tumor control rates seem to be comparable even with those reported for large LINAC-SRS [10–12, 37] or GK-SRS series [7, 38, 39].…”

Section: Discussionmentioning

confidence: 57%

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Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors

et al. 2014

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To determine visual outcome including the occurrence of radiation induced optic neuropathy (RION) as well as tumor control after fractionated stereotactic radiation therapy (FSRT) of benign anterior skull base meningiomas or pituitary adenomas. Thirty-nine patients treated with FSRT for anterior skull base meningiomas and 55 patients treated with FSRT for pituitary adenomas between January 1999 and December 2009 with at least 2 years follow-up were included. Patients were followed up prospectively with magnetic resonance imaging scans, visual acuity and visual field examinations. RION was found in four (10 %) patients with anterior skull base meningiomas and seven patients (13 %) with pituitary adenomas. The five-year actuarial freedom from 25 % RION visual field loss was 94 % following FSRT. Actuarial 2-, 5- and 10-year tumor control rates were 100, 88.4 and 64.5 % for anterior skull base meningiomas and 100, 98.2 and 94.9 % for pituitary adenomas, respectively. Patients with an impaired visual field function pre-FSRT were more likely to experience worsened function (p = 0.016). We found that RION, was a relatively uncommon event, in a large prospective cohort of patients that were systematically monitored following FSRT of benign anterior skull base tumors. Long term tumor control was favorable, especially for pituitary adenomas.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 57%

Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors

et al. 2014

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“…In these studies, RT was used predominantly for tumors in difficult to surgically access locations such as the optic nerve sheath or cavernous sinus, for patients regarded as inoperable for medical reasons, or for those who chose primary RT over surgery. 32,66,67,71,76,80,104,116,129 These studies show that RT achieved long-term local control in 68% to 100% of WHO grade I or presumed grade I meningioma at 5 to 10 years, including patients treated post-operatively, primarily, or following recurrence. Results varied somewhat by treatment era, tumor size and location, and clinical setting.…”

Section: Resultsmentioning

confidence: 71%

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Rogers

Barani

Chamberlain

et al. 2015

JNS

553

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Evolving interest in meningioma, the most common primary brain tumor, has refined contemporary management of these tumors. Problematic, however, is the paucity of prospective clinical trials that provide an evidence-based algorithm for managing meningioma. The current review summarizes the published literature regarding the treatment of newly diagnosed and recurrent meningioma, with an emphasis on outcomes stratified by World Health Organization (WHO) tumor grade. In particular this review focuses on patient outcomes following treatment (either adjuvant or at recurrence) with surgery or radiation therapy inclusive of radiosurgery and fractionated irradiation. Phase II trials for patients with meningioma have recently completed accrual within the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) consortia, and phase III studies are being developed. However, at present, there are no completed prospective, randomized trials assessing the role of either surgery or radiotherapy. Successful completion of future studies will require a multidisciplinary effort, dissemination of the current knowledge base, improved implementation of WHO grading criteria, standardization of response criteria and other outcome endpoints, and concerted efforts to address weaknesses in present treatment paradigms, particularly for patients with progressive or recurrent low grade meningioma, or with high-grade meningioma. In parallel efforts, Response Assessment in Neuro-Oncology (RANO) subcommittees are developing a manuscript on systemic therapies for meningioma, and a separate article proposing standardized endpoint and response criteria for meningioma.

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“…large growing tumor causing significant symptoms, or special locations, such as involvement of critical structures such as the cavernous sinus or the optic nerve, or close contact with critical structures, external beam fractionated radiotherapy (FRT) remains an alternative. Numerous studies have reported that FRT decreases tumor recurrence and improves survival, after partial tumor resection or as primary treatment for unresectable meningiomas, such as optic nerve sheath and cavernous sinus meningioma (Table 1) [16][17][18][19][20][21][22][23][24]. However, most series report uni-or multicenter retrospective experience.…”

Section: Introductionmentioning

confidence: 99%

Fractionated radiotherapy and radiosurgery of intracranial meningiomas

et al. 2018

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

Cited by 49 publications

References 45 publications

Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors

Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Fractionated radiotherapy and radiosurgery of intracranial meningiomas

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