Gamma Knife stereotactic radiosurgery for cavernous sinus meningioma: long-term follow-up in 200 patients

Abstract

OBJECTIVE The authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM). METHODS The authors retrospectively assessed treatment outcomes 5-18 years after SRS in 200 patients with CSM. The median patient age was 57 years (range 22-83 years). In total, 120 (60%) patients underwent Gamma Knife SRS as primary management, 46 (23%) for residual tumors, and 34 (17%) for recurrent tumors after one or more surgical procedures. The median tumor target volume was 7.5 cm (range 0.1-37.3 cm), and the median margin dose was 13.0 Gy (range 10-20 Gy). RESULTS Tumor volume regressed in 121 (61%) patients, was unchanged in 49 (25%), and increased over time in 30 (15%) during a median imaging follow-up of 101 months. Actuarial tumor control rates at the 5-, 10-, and 15-year follow-ups were 92%, 84%, and 75%, respectively. Of the 120 patients who had undergone SRS as a primary treatment (primary SRS), tumor progression was observed in 14 (11.7%) patients at a median of 48.9 months (range 4.8-120.0 months) after SRS, and actuarial tumor control rates were 98%, 93%, 85%, and 85% at the 1-, 5-, 10-, and 15-year follow-ups post-SRS. A history of tumor progression after microsurgery was an independent predictor of an unfavorable response to radiosurgery (p = 0.009, HR = 4.161, 95% CI 1.438-12.045). Forty-four (26%) of 170 patients who had presented with at least one cranial nerve (CN) deficit improved after SRS. Development of new CN deficits after initial microsurgical resection was an unfavorable factor for improvement after SRS (p = 0.014, HR = 0.169, 95% CI 0.041-0.702). Fifteen (7.5%) patients experienced permanent CN deficits without evidence of tumor progression at a median onset of 9 months (range 2.3-85 months) after SRS. Patients with larger tumor volumes (≥ 10 cm) were more likely to develop permanent CN complications (p = 0.046, HR = 3.629, 95% CI 1.026-12.838). Three patients (1.5%) developed delayed pituitary dysfunction after SRS. CONCLUSIONS This long-term study showed that Gamma Knife radiosurgery provided long-term tumor control for most patients with CSM. Patients who underwent SRS for progressive tumors after prior microsurgery had a greater chance of tumor growth than the patients without prior surgery or those with residual tumor treated after microsurgery.

Radiotherapy of Parasellar Tumours

“…The reported tumour control after proton beam RT is ranged from 90 to 96% at 5 years, similar to that observed with fractionated photon techniques (Table 2) [43,44]. The reported actuarial control rates after SRS is in the range of 90-95% at 5 years and 80-90% at 10 and 15 years using a median margin dose to the tumour of 13-15 Gy, with a variable improvement of neurological functions in up to 60% of patients [45][46][47][48][49][50][51][52][53][54][55][56]. The rate of significant complications at doses of 13-15 Gy is < 10%, being represented by either transient or permanent complications [45,51].…”

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients

“…9,15,25 Some recent studies that were focused on the treatment of intracranial meningiomas with radiosurgery reported that the local tumor control rates ranged from 88% to 100%, in which 19%-74% of tumors shrank during a mean follow-up of 36-78 months. 3,7,12,21,22,[30][31][32][33][34]37,[39][40][41] In a single-center study, Hasegawa et al 12 reported an actuarial PFS rate of 92%, 86%, and 72% at 3, 5, and 10 years, respectively, in 67 patients. In a meta-analysis of SRS for skull base meningiomas, Starke et al 41 reviewed the outcome in 469 patients with large skull base meningiomas (> 8 cm) from several centers, and reported that the actuarial tumor PFS rates at 3, 5, and 10 years were 90.3%, 88.6%, and 77.2%, respectively.…”

“…Parameters of tumor control were defined as 1) tumor progression (tumor volume increased ≥ 10% compared to the volume at GKRS); 2) tumor regression (tumor volume shrinkage ≥ 10%); or 3) tumor unchanged (tumor volume change < 10%). 5,30,34 There was no distant metastasis. Tumor volume was computed by measuring the maximum diameter at the horizontal, coronal, and sagittal planes of the MR images.…”

“…The median interval between primary resection and radiosurgery was 5 months (range 3 ), consisting of 48 (30.8%) large tumors (volume ≥ 10 cm 3 ) and 108 (69.2%) small and moderate tumors (volume < 10 cm 3 ) were under treatment by GKRS. 30 Categorized by tumor site, the percentages were as follows: convexity meningiomas (16.7%), parafalcine and parasagittal meningiomas (17.9%), sellar and parasellar meningiomas (17.3%), petroclival meningiomas (14.7%), cerebellopontine angle (CPA) meningiomas (13.5%), tentorial meningiomas (10.2%), foramen magnum meningiomas (1.3%), sphenoidal meningiomas (6.4%), and olfactory meningiomas (1.9%). 21,22,41 There were 73 (46.8%) residual or progressive tumors with a median volume of 8.9 cm 3 (range 0.33-45.78 cm 3 ), and 83 (53.2%) initial tumors with a median volume of 2.6 cm 3 (range 0.23-21.1 cm 3 ).…”

Parasellar Meningiomas

“…In WHO grade I parasellar meningiomas, the outcome of radiosurgery is favorable [105][106][107][108][109]. The long-term recurrence rate also appears to be favorable but remains uncertain [110]. The risk of remote recurrence is persistent, whereas the risk of tumor transformation remains uncertain.…”