Long-term disease control and treatment outcomes of stereotactic radiosurgery in cavernous sinus meningiomas

2021 ◽  
Author(s):  
Rafael Martinez-Perez ◽  
William Florez-Perdomo ◽  
Lindsey Freeman ◽  
Timothy H. Ung ◽  
A. Samy Youssef
Keyword(s):  
Disease Control ◽  
Treatment Outcomes ◽  
Stereotactic Radiosurgery ◽  
Cavernous Sinus

scholarly journals Treatment outcomes following leukemic transformation in Philadelphia-negative myeloproliferative neoplasms

Blood ◽  
2013 ◽  
Vol 121 (14) ◽  
pp. 2725-2733 ◽  
Author(s):  
James A. Kennedy ◽  
Eshetu G. Atenafu ◽  
Hans A. Messner ◽  
Kenneth J. Craddock ◽  
Joseph M. Brandwein ◽  
...  
Keyword(s):  
Disease Control ◽  
Treatment Outcomes ◽  
Myeloproliferative Neoplasms ◽  
Leukemic Transformation ◽  
Curative Intent ◽  
Key Points

Key Points Induction followed by allo-transplantation can achieve long-term disease control in select patients with AML arising from a Ph-MPN. In this population, transplant should be the goal in patients treated with curative intent, as induction alone provides limited benefit.

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

2019 ◽  
Vol 130 (6) ◽  
pp. 1799-1808 ◽  
Author(s):  
Kyung-Jae Park ◽  
Hideyuki Kano ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
Daniel A. Tonetti ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Cavernous Sinus Meningioma ◽  
Long Term Study

OBJECTIVEThe authors of this study evaluate the long-term outcomes of stereotactic radiosurgery (SRS) for cavernous sinus meningioma (CSM).METHODSThe 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 cm3 (range 0.1–37.3 cm3), and the median margin dose was 13.0 Gy (range 10–20 Gy).RESULTSTumor 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 cm3) 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.CONCLUSIONSThis 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.

Does Prior Microsurgery Improve or Worsen the Outcomes of Stereotactic Radiosurgery for Cavernous Sinus Meningiomas?

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 401-410 ◽  
Author(s):  
Hideyuki Kano ◽  
Kyun-Jae Park ◽  
Douglas Kondziolka ◽  
Aditya Iyer ◽  
Xiaomin Liu ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Improvement Rate ◽  
Cranial Nerve Function ◽  
Cranial Neuropathies ◽  
Microsurgical Resection

Abstract BACKGROUND: Stereotactic radiosurgery (SRS) is an important option for patients with cavernous sinus meningiomas. OBJECTIVE: To evaluate cranial nerve outcomes in patients who underwent SRS for cavernous sinus meningiomas with or without prior microsurgery. METHODS: During a 23-year interval, 272 patients underwent Gamma Knife SRS for cavernous sinus meningiomas (70 men, 202 women; median age, 54 years). In this series, 99 patients underwent prior microsurgical resection. The median tumor volume was 7.9 cm3 and median marginal dose was 13 Gy. The median follow-up period was 62 months (range, 6-209 months). RESULTS: The progression-free survival after SRS was 96% at 3 years, 94% at 5 years, and 86% at 10 years. After SRS, 13 of 91 patients (14%) who underwent prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. In comparison, 54 of 145 patients (37%) without prior microsurgery had improvement of preexisting cranial nerve symptoms or signs. The improvement rate of cranial nerve deficits after SRS in patients without prior microsurgery was 20% at 1 year, 34% at 2 years, 36% at 3 years, and 39% at 5 years. Patients who had not undergone prior microsurgery had significantly higher improvement rates of preexisting cranial nerve symptoms and signs (P = .001). After SRS, 29 patients (11%) developed new or worsened cranial nerve function. CONCLUSION: SRS provided long-term effective tumor control and a low risk of new cranial nerve deficits. Improvement in preexisting cranial neuropathies was detected in significantly more patients who had not undergone prior microsurgical procedures.

scholarly journals P12.07 Long term follow-up of cavernous sinus meningiomas after stereotactic radiosurgery

2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii96-iii96
Author(s):  
R. Daniel ◽  
F. Fritsche ◽  
S. Grau ◽  
H. Treuer ◽  
M. Kocher ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Long Term Follow Up

Long-Term Outcomes of Stereotactic Radiosurgery for Treatment of Cavernous Sinus Meningiomas

2011 ◽  
Vol 81 (5) ◽  
pp. 1436-1441 ◽  
Author(s):  
Marcos Antonio dos Santos ◽  
José Bustos Pérez de Salcedo ◽  
José Angel Gutiérrez Diaz ◽  
Felipe A. Calvo ◽  
José Samblás ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Long Term Outcomes

Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas

2001 ◽  
Vol 95 (3) ◽  
pp. 435-439 ◽  
Author(s):  
Masahiro Shin ◽  
Hiroki Kurita ◽  
Tomio Sasaki ◽  
Shunsuke Kawamoto ◽  
Masao Tago ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Univariate Analysis ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Long Term Outcome ◽  
Content Type ◽  
Fine Print

Object. The long-term outcome of stereotactic radiosurgery for cavernous sinus (CS) meningiomas is not fully understood. The authors retrospectively reviewed their experience with 40 CS meningiomas treated with gamma knife radiosurgery. Methods. Follow-up periods for the 40 patients ranged from 12 to 123 months (median 42 months), and the overall tumor control rates were 86.4% at 3 years and 82.3% at 10 years. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). When the tumor was completely covered with a dose to the margin that was higher than 14 Gy (Group A, 22 patients), no patient showed recurrence within the median follow-up period of 37 months. On the other hand, when a part of the tumor was treated with 10 to 12 Gy (Group B, 15 patients) or did not receive radiation therapy (Group C, three patients), the recurrence rates were 20% and 100%, respectively. Neurological deterioration was seen in nine patients, but all symptoms were transient or very mild. Conclusions. The data indicate that stereotactic radiosurgery can control tumor growth if the whole mass can be irradiated by dosages of more than 14 Gy. When optimal radiosurgical planning is not feasible because of a tumor's large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications.

scholarly journals Cavernous sinus meningiomas

2018 ◽  
Vol 20 (2) ◽  
pp. 110-118
Author(s):  
Roberto Spiegelmann ◽  
Zvi R. Cohen ◽  
Uzi Nissim
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Linear Accelerator ◽  
Medical Center ◽  
Neurological Complications ◽  
Formidable Challenge ◽  
Long Term Follow Up ◽  
Low Incidence

Introduction: Tumors of the cranial base arising from or partially involving the cavernous sinus have represented a formidable challenge to neurosurgeons. Stereotactic radiosurgery represents an alternative to microsurgery for the management of cavernous sinus meningiomas. The present study aims to evaluate the results of radiosurgery in a large series of patients treated with a linear accelerator with a long-term follow-up. Patients and Methods: From 1993 through 2007, 462 patients with meningiomas underwent radiosurgery at the Chaim Sheba Medical Center LINAC radiosurgery unit. Of those, 117 had tumors involving predominantly the cavernous sinus. A mean follow-up of 67 months was obtained in 102 patients (range:12 to 180 months). Patients’ age ranged from 31 to 86 years (mean 57). Seventy two (70%) were females. Thirty five patients (34.3%) were initially submitted to microsurgery and 67 (65.6%) underwent stereotactic radiosurgery as the first treatment option. Patients were treated using a linear accelerator with cylindrical collimators in 44 patients (43.1%) and a minimultileaf collimator in 58 patients (56.8%). The prescription dose was delivered to the 60 to 80% isodose line (mean, 68%) in patients treated with cylindrical collimators, and to the 80% in those treated with a single conformal isocenter. Doses ranged between 12 and 17.5 Gy (mean, 13.5 Gy). Median tumor volume was 7.2 cm3 (range 0.61–23 cm3). Results: All patients were available for follow-up at 12 to 180 months after treatment (mean, 68 months; median, 60 months). The actuarial control rate was 98%. Fifty nine  patients (58%) had a volume reduction and forty one (40%) had stable tumor volumes at the end of follow-up. Two tumors grew. Overall, 4 patients had a new lasting neurological deficit (facial hypesthesia or pain in two, trochlear neuropathy in two, and visual defect in one), for an incidence of 4% in persistent neurological complications. Conclusions: This series of linear accelerator radiosurgery confirms that in the short and long term, radiosurgery affords excellent control for cavernous sinus meningiomas with a very low incidence of complications. Radiosurgery can thus be regarded as the treatment of choice for cavernous sinus meningiomas. 

scholarly journals Stereotactic Radiosurgery of Cavernous Sinus Meningiomas

2019 ◽  
Vol 81 (02) ◽  
pp. 158-164
Author(s):  
Daniel Rueß ◽  
Fenja Fritsche ◽  
Stefan Grau ◽  
Harald Treuer ◽  
Mauritius Hoevels ◽  
...  
Keyword(s):  
Side Effects ◽  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Symptom Control ◽  
High Rate ◽  
Tumor Control ◽  
Incomplete Resection ◽  
Kaplan Meier ◽  
Microsurgical Resection

Abstract Objective Microsurgical resection of cavernous sinus meningiomas (CSM) is associated with a high rate of incomplete resection, recurrence, and the risk for permanent, severe cranial nerve deficits. Stereotactic radiosurgery (SRS) has evolved as alternative treatment for primary and recurrent CSM. Here, we report about the long-term clinical and radiological follow-up (FU) of a unique cohort of patients with CSM treated with LINAC or Cyberknife based SRS. Methods In this single-center retrospective analysis, we include all patients with CSM who underwent single fraction SRS between 1993 and 2016. Clinical and radiological tumor control were evaluated by the Kaplan–Meier method. Additionally, patient data were analyzed in terms of symptom control and incidence of side effects rated by the common terminology criteria for adverse events (CTCAE; v4.03). Results 116 patients (female/male = 91/25; median age, 54 years; range, 33–82 years) were included. Mean tumor volume was 5.7 ± 3.3 cm3 (range, 0.6–16.2 cm3), the median marginal dose was 12.6 Gy applied to isodose levels of 75%. Median clinical FU was 55 months (range, 3–226 months). Tumor control was 98% after 2 and 5 years and 90% after 10 years. Twelve patients (10.3%) had permanent or transient radiation related toxicity (CTCAE I–III). An improvement of symptoms was observed in 26.7% of the symptomatic patients (n = 20 of 75). Conclusion SRS for CSM provides excellent long-term tumor and symptom control without considerable permanent side effects. Thus, SRS should be considered when counseling patients suffering from CSM.

Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas

2002 ◽  
Vol 97 (1) ◽  
pp. 65-72 ◽  
Author(s):  
John Y. K. Lee ◽  
Ajay Niranjan ◽  
James McInerney ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
External Beam Radiation ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Beam Radiation ◽  
Content Type ◽  
Tumor Control Rate ◽  
Fine Print

Object. To evaluate long-term outcomes of patients who have undergone stereotactic radiosurgery for cavernous sinus meningiomas, the authors retrospectively reviewed their 14-year experience with these cases. Methods. One hundred seventy-six patients harbored meningiomas centered within the cavernous sinus. Seventeen patients were lost to follow-up review, leaving 159 analyzable patients, in whom 164 procedures were performed. Seventy-six patients (48%) underwent adjuvant radiosurgery after one or more attempts at surgical resection. Eighty-three patients (52%) underwent primary radiosurgery. Two patients (1%) had previously received fractionated external-beam radiation therapy. Four patients (2%) harbored histologically verified atypical or malignant meningiomas. Conformal multiple isocenter gamma knife surgery was performed. The median dose applied to the tumor margin was 13 Gy. Neurological status improved in 46 patients (29%), remained stable in 99 (62%), and eventually worsened in 14 (9%). Adverse effects of radiation occurred after 11 procedures (6.7%). Tumor volumes decreased in 54 patients (34%), remained stable in 96 (60%), and increased in nine (6%). The actuarial tumor control rate for patients with typical meningiomas was 93.1 ± 3.3% at both 5 and 10 years. For the 83 patients who underwent radiosurgery as their sole treatment, the actuarial tumor control rate at 5 years was 96.9 ± 3%. Conclusions. Stereotactic radiosurgery provided safe and effective management of cavernous sinus meningiomas. We believe it is the preferred management strategy for tumors of suitable volume (average tumor diameter ≤ 3 cm or volume ≤ 15 cm3).

scholarly journals Gamma Knife Surgery for Cavernous Sinus Meningiomas

2018 ◽  
Vol 25 (3) ◽  
pp. 200-204
Author(s):  
Julio C. Antico
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Organs At Risk ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Surgical Morbidity ◽  
Maximal Diameter

Introduction: Patients with cavernous sinus meningiomas (CSM) have an elevated risk of surgical morbidity and mortality. Recurrence is often observed after partial resection. Stereotactic radiosurgery (SRS), either alone or combined with surgery, represents an important advance in CSM management, but long-term results are still lacking. Methods and Materials: A total of 98 CSM patients, treated from January 2000 to December 2013, were retrospectively reviewed. The mean follow-up was 86.8 months (range = 17.1–179.4 months). Among the patients, 15 were followed for more than 10 years. There was a female predominance (75.46%). The age varied from 24 to 79 years (mean = 49.6). From all, 98 patients, 57 (53.4%) received SRS alone, and 41 patients (46.6%) had undergone surgery before Gamma-knife surgery (GKS). A dose of 14 Gy was prescribed to isodose curves from 50% to 90%. In 25 patients (28.4%), as a result of the proximity to organs at risk, the prescribed dose did not completely cover the target. Results: After GKS, 53 (51.9%) patients presented with tumor volume reduction; 36 (35.2%) remained stable, and 9 (8.8%) had tumor progression. The progression-free survival was 87.23% at 5 years, and 79.5% at 10 years. Age, sex, maximal diameter of the treated tumor, previous surgery, and complete target stereotactic radiosurgery can control tumor growth if the whole mass can be irradiated by dosages of more than 14 Gy. When optimal radiosurgical planning is not feasible because of large size, irregular shape, or proximity of the tumor to visual pathways, the use of limited surgical resection before radiosurgery is the best option, and should provide sufficient long-term tumor control with minimal complications.

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