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Acta Neurochirurgica

, Volume 160, Issue 12, pp 2367–2378 | Cite as

Radiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis

  • Henri-Arthur LeroyEmail author
  • Constantin Tuleasca
  • Nicolas Reyns
  • Marc Levivier
Review Article - Tumor - Meningioma
Part of the following topical collections:
  1. Tumor – Meningioma

Abstract

Introduction

Radiosurgery (RS) and fractionated radiotherapy (FRT) are part of the therapeutic armamentarium for the management of cavernous sinus meningiomas. We propose a systematic review of the local tumor control and clinical outcomes after monofractionated radiosurgical treatment, including gamma knife radiosurgery (GKRS) and linear accelerator (Linac RS), or fractionated radiotherapy.

Materials and Methods

The current review and meta-analysis adhered to the PRISMA guidelines. We performed a search in PubMed, Embase, and Medline based on the following mesh terms, used alone or in diverse combinations, in both title and abstract: “cavernous sinus,” “meningioma,” “radiosurgery,” “gamma knife,” “linac,” “cyberknife,” and “radiotherapy”. We screened 425 studies. We selected 36 studies, matching all selection criteria: 24 for GK, 5 for Linac, and 7 for FRT.

Results

Were included 2817 patients (GKRS, n = 2047, LinacRS, n = 350, FRT, n = 420). Half of patients benefited from upfront RS or FRT; the other half benefited from adjuvant RS or FRT (combined approach or tumor recurrence). The mean gross target volume (GTV) was smaller for RS as compared to FRT (p = 0.07). The median marginal doses were 13.9 Gy (range, 11 to 28) for GKRS and 14 Gy (range, 12.8 to 17.7) for LinacRS. For FRT, patients received a mean dose of 51.2 Gy (25.5 fractions, 1.85 Gy each). The mean overall follow-up values were 48 months (range, 15 to 89) for GKRS, 69 months (range, 46 to 87) for Linac, and 59.5 months (range, 33 to 83) for FRT. PFS at 5 years for GKRS, LinacRS, and FRT were respectively 93.6%, 95.6%, and 97.4% (p = 0.32, the Kruskal-Wallis). Monofractionated treatments (GKRS and LinacRS) induced more tumor volume regression than FRT (p = 0.001). Tumor recurrence or progression ranged between 3 and 5.8%, without statistically significant differences between modalities (p > 0.05). Trigeminal symptoms improved in approximately 54%, and III-IV-VI cranial nerves (CN) palsies improved in approximately 45%. After GKRS, visual acuity improved in 21% (not enough data available for other modalities). De novo deficits occurred in 5 to 7.5%. Adverse radiation effects appeared in 4.6 to 9.3% (all techniques pooled).

Conclusion

RS achieved a twice-higher rate of tumor volume regression than FRT. GKRS series reported an improvement in visual acuity in 21% of the cases. GKRS, Linac, and FRT provided similar clinical post therapeutic outcomes for the trigeminal and oculomotor CN.

Keywords

Cavernous sinus meningioma Radiosurgery Radiotherapy Gamma knife 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Henri-Arthur Leroy
    • 1
    • 2
    • 3
    Email author
  • Constantin Tuleasca
    • 1
    • 4
    • 5
  • Nicolas Reyns
    • 2
  • Marc Levivier
    • 1
    • 4
  1. 1.Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife CenterCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  2. 2.Department of Neurosurgery and Neuro-oncologyCHU LilleLilleFrance
  3. 3.Department of NeurosurgeryLille University HospitalLille CedexFrance
  4. 4.Faculty of Biology and MedicineUniversity of LausanneLausanneSwitzerland
  5. 5.Signal Processing Laboratory (LTS-5)Ecole Polytechnique Fédérale de LausanneLausanneSwitzerland

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