Artikel
Management of meningiomas (WHO I) involving the cavernous sinus – long-term tumour control and functional outcome
Therapie von Sinus-Cavernosus WHO Grad I Meningeomen – Langzeitanalyse
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Preservation of function in patients harboring meningiomas WHO grade I involving the cavernous sinus (CSM) is crucial in the light of sufficient tumor control. Concise data on the functional outcome of an interdisciplinary, multimodal treatment concept are scarce. We analyzed functional outcome and long-term tumor control in CSM patients following microsurgical tumor resection, fractionated stereotactic radiotherapy (FSRT) or a combination thereof.
Methods: Patients with CSM treated between 2003 and 2017 were included in this retrospective study. Prior to FSRT a 68Ga-DOTATATE PET/CT was performed for radiation planning. Volumetric analysis was performed on gadolinium enhanced MRI (BrainLab elements software). Progression-free survival (PFS) was analyzed using the Kaplan-Meier method, the log-rank test was performed to test differences between groups. Cranial nerve function including visual acuity and visual field were analyzed at baseline and during follow-up.
Results: A total of 85 patients with CSM matched the inclusion criteria. Following interdisciplinary tumor board recommendation, 48 patients underwent microsurgical tumor resection (group A), 25 patients received a resection followed by FSRT within 6 months (group B) and 12 patients were treated with FSRT alone (group C). Median total tumor volume and intracranial tumor volume were significantly higher in group A (11.4 cm3/9.5 cm3) and B (13.5 cm3/10.3 cm3) than in group C (4.32 cm3/2.3 cm3). The median follow-up time was 47 months in group A, 46 months in group B and 45 months in group C. 18 patients (37.5%) of group A developed a tumor recurrence whereas no progression was observed in group B and C. PFS at 5-years was 55.7%, 100%, and 100% in groups A, B, and C (p<0.001). Indications for maximal surgical resection were space occupying tumors and compression of the optic nerve. Incidence of optic nerve compression was significantly higher in Group A (n=43) and B (n=19) than in group C (n=0). Post-therapeutic new onset or deterioration of double vision was observed 29 % (group A), 17 % (group B) and 0% in group C. A deterioration of visual field occurred in 9% (A),17% (B) and 0% (C) of patients.
Conclusion: In large meningiomas with involvement of the cavernous sinus, a combination of tailored resection and subsequent radiotherapy provides very good results concerning tumor control and functional outcome. In small lesions without the necessity of surgical intervention, radiotherapy alone leads to excellent outcome.