Document Detail


Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?
MedLine Citation:
PMID:  11220370     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We report the long-term follow-up of 31 patients with cavernous sinus meningiomas who were treated either with surgery and radiotherapy (RT) or with RT alone. This retrospective review was undertaken to compare long-term efficacy and morbidity of RT with or without previous surgery versus complete, aggressive surgical removal. METHODS: Between 1980 and 1997, we performed a retrospective study of 31 patients harboring cavernous sinus meningiomas. The patient group comprised 25 women and 6 men. Patients were divided into two therapeutic categories: patients treated with surgery and RT (Group I, 17 patients) and patients treated with RT alone (Group II, 14 patients). Twenty-five patients (14 in Group I and 11 in Group II) were treated for primary tumors, and 6 patients (3 in Group I and 3 in Group II) were treated for recurrent disease. All three patients who were treated by RT alone at the time of recurrent disease had had previous surgery as initial treatment. Tumor control, treatment morbidity, and functional outcomes were evaluated for all patients. Twenty-eight patients were alive at the time of analysis, with a median follow-up period of 6.1 years. RESULTS: The progression-free survival rate was 92.8% at 10-year follow-up. Only two patients exhibited tumor progression after initial treatment. One of the patients who experienced tumor regrowth 4 years after surgery and RT benefited from additional conventional external beam radiation, and this patient exhibited no evidence of tumor progression at the last follow-up examination 6 years later. Two patients experienced cranial nerve impairment after surgery, and no patients developed late radiation toxicity. Follow-up status as measured by the Karnofsky Performance Scale deteriorated in 7% of patients and was the same or improved in 93% of patients. CONCLUSION: The results of combined surgery and RT or RT alone indicated a high rate of tumor control and a low risk of complications. Complete aggressive surgical removal of cavernous sinus meningiomas is associated with an increased incidence of morbidity and mortality and does not demonstrate a better rate of tumor control. Conventional external beam radiation seems to be an efficient and safe initial or adjuvant treatment of these lesions, and these findings should serve as a basis for evaluating new alternatives such as radiosurgery or stereotactic RT.
Authors:
H Dufour; X Muracciole; P Métellus; J Régis; O Chinot; F Grisoli
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  48     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-02-23     Completed Date:  2001-05-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  285-94; discussion 294-6     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University of Aix-Marseille II, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cavernous Sinus* / pathology
Combined Modality Therapy
Female
Humans
Magnetic Resonance Imaging
Male
Meningeal Neoplasms / mortality,  physiopathology,  radiotherapy*,  surgery*
Meningioma / mortality,  physiopathology,  radiotherapy*,  surgery*
Middle Aged
Postoperative Complications
Quality of Life
Radiation Injuries
Survival Analysis
Treatment Outcome
Visual Fields

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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