Stereotactic radiosurgeryVII. Radiosurgery versus conventionally-fractionated radiotherapy in the treatment of cavernous sinus meningiomas

Abstract

Twenty-eight patients with meningiomas involving the cavernous sinus were referred to the radiosurgical service at St. Bartholomew's Hospital 1989-1998.The majority (8/13) of patients with small (<3 cm diameter) tumours received radiosurgery whereas the majority of large tumours (>3 cm diameter; 12/15) received conventionally-fractionated radiotherapy. Other treatment recommendations were fractionated radiosurgery (one case) and conventionally-fractionated radiotherapy to the whole meningeal base and a radiosurgery boost (three cases). Fractionated radiosurgery is optimal where the target volume is small, but abuts critically sensitive nervous system.There have been no progressions of disease at relatively early follow-up. It is argued that subtotal excision followed by appropriate dose radiation therapy is often a strong competitor to attempted radical excision given the attendant morbidity of this latter operation for meningiomas at this site. Patients referred for radiation therapy are best served by a department with both radiosurgery and conventional radiation therapy facilities.

• Cavernous Sinus Meningioma;Conventionally-fractionated Radiation;Fractionated Radiosurgery;Stereotactic Radiosurgery