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?

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 lon g-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 pa tients harboring cavernous sinus meningiomas. The patient group comprised 2 5 women and 6 men. Patients were divided into two therapeutic categories: p atients treated with surgery and RT (Group I, 17 patients) and patients tre ated with Ri alone (Group II, 14 patients). Twenty-five patients (14 in Gro up 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 thre e patients who were treated by RT alone at the time of recurrent disease ha d had previous surgery as initial treatment. Tumor control, treatment morbi dity, and functional outcomes were evaluated for all patients. Twenty-eight patients were alive at the time of analysis, with a median follow-up perio d 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 R T benefited from additional conventional external beam radiation, and this patient exhibited no evidence of tumor progression at the last follow-up ex amination 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% o f 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 aggres sive surgical removal of cavernous sinus meningiomas is associated with an increased incidence of morbidity and mortality and does not demonstrate a b etter rate of tumor control. Conventional external beam radiation seems to be an efficient and safe initial or adjuvant treatment of these lesions, an d these findings should serve as a basis for evaluating new alternatives su ch as radiosurgery stereotactic RT.