Artikel
Long term follow-up of cavernous sinus meningiomas after stereotactic radiosurgery
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Microsurgical resection of cavernous sinus meningiomas (CSM) is challenging with a high percentage of recurrence due to incomplete resection (>10% reported recurrence rate after Simpson Grade II and >20% after Grade III resections) and/or permanent, partly severe cranial nerve deficits. Stereotactic radiosurgery (SRS) has evolved as alternative first-line treatment for SCM. Here, we report about the long term clinical and radiological follow-up of an unique cohort of patients with CSM treated with LINAC based SRS.
Methods: In this single center retrospective analysis we included all patients with SCM who underwent single fraction LINAC SRS between 1993 and 2012 and had a minimum follow-up of 3 months. We evaluated tumor control (no further intervention needed) by the Kaplan-Meier method. Additionally, patient data were analyzed in terms of clinical symptom control and incidence of complications or unexpected side effects rated by Common Terminology Criteria for Adverse Events (CTCAE; v4.03).
Results: 82 patients with 83 tumors (f/m =62/20, median age 53 ± 11, range 33-81 years) were identified. Mean tumor volume was 5.8 ± 3.5 cm3 (range, 0.6-16 cm3), the mean marginal dose was 12 ± 2 Gy (range, 7.0-18.75 Gy) at isodose levels of 64 ± 17% (range, 30-85%). Median follow-up (FU) was 57 months (range, 3-226 months). Tumor control was 100% after 6 and 12 months, 97% after 5-years and 94% after 10 years. Symptoms prior to SRS remained stable in 88% (n=73), improved in 3.6% (n=3) and deteriorated in 2.4% (n=2) at last follow-up. Four patients (4.8%) report about adverse events CTCAE grade 1 (headache n=2, somnolence n=1, trigeminus disorder n=1).
Conclusion: SRS for SCM provides reliable long term tumor control without considerable permanent side effects. Thus, SRS should be taken into account when counselling patients harbouring CSM.