Therapeutic Effect of Hypofractionated Stereotactic Radiotherapy Using CyberKnife for High Volume Cavernous Sinus Cavernous Hemangiomas

Abstract

Objective: To evaluate the efficacy and safety of hypofractionated stereotactic radiotherapy using CyberKnife for high volume cavernous sinus cavernous hemangiomas. Materials and Methods: We collected data from 12 patients with high volume cavernous sinus cavernous hemangiomas treated with hypofractionated stereotactic radiotherapy using CyberKnife in our institute, including 2 men and 10 women/female child, aged 4 to 60 years. Initial tumor volumes ranged from 11.8 to 96.6 cm3 with a median of 24.3 cm3. Irradiation doses were 19.5 Gy with 3 fractions in 2 patients, 21 Gy with 3 fractions in 8 patients, 25 Gy with 5 fractions in 1 patient, and 30 Gy with 3 fractions in 1 patient. We used 109 to 155 beams during treatment, and target volumes reached over 95% of the prescribed dose. Follow-up ranged from 3 to 54 months. We evaluated the efficacy and safety of the CyberKnife system based on changes in the diagnostic images and involved cranial nerves or symptoms. Results: Of the 12 patients, 11 were followed for 3 to 54 months with a mean follow-up of 16.3 months; 1 patient was lost to in-person follow-up. Lesion volumes in the followed 11 patients were calculated after fractionated radiotherapy. All tumor volumes decreased (28.6%-94.1%) and symptoms improved (including blurred vision, visual field defects, diplopia, headaches, and facial numbness) after therapy. Postoperative magnetic resonance images revealed a tumor volume range of 2.8 to 41.0 cm3 (median, 6.5 cm3), significantly lower compared with the pretreatment range of 11.8 to 70.1 cm3 (median, 24.3 cm3; T = 0.00, P = .003 < .05). A single patient experienced radiotherapy-related cerebral edema, which resolved after 5 days of mannitol and dexamethasone. Conclusions: Based on the current results, though preliminary, hypofractionated stereotactic radiotherapy using CyberKnife is an effective and safe alternative for high volume cavernous sinus cavernous hemangiomas and is the recommended primary treatment in high-risk patients with this condition.

Long-term outcomes of staged Gamma Knife radiosurgery for giant cavernous sinus hemangiomas: a single-center retrospective study

“…CyberKnife treatment [18][19][20] and radiotherapy 22,23 have both been reported to result in impressive tumor control and low side-effect incidence in treating large or giant CSHs, findings which also indicate the sensitivity of CSHs to radiation treatment. In comparison, the radiation dose of GKRS is distributed in layers, like an onion, which makes the radiation dose to the tumor center 2 times higher than the dose to the tumor margin.…”

“…In addition to GKRS, the reported therapies for giant CSHs include microsurgical resection, [2][3][4][5]28 CyberKnife therapy, [18][19][20] and radiotherapy. 22,23 Li et al 2 retrospectively reviewed surgical results of 47 patients with large-volume CSHs and gross-total resection in 26 (55.3%) cases with average intraoperative blood loss of 650 ml (range 100-3500 ml), and found that increased tumor size was a risk factor for unfavorable outcomes.…”

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Cavernous sinus hemangiomas (CSHs) are benign tumors originating from the cavernous sinus, accounting for 2%-3% of tumors in the cavernous sinus area, 1 which usually occur in female patients aged 40-50 years, with diplopia and ptosis as the first symptom or without any symptoms.The main treatments for CSHs include microsurgery 2-5 and stereotactic radiosurgery. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Despite improvements in microsurgery techniques and postoperative management, the rate of complications after aggressive microsurgical removal of CSHs remains high due to the complex anatomy of cavernous sinus area and severe intraoperative bleeding. Iwai et al 21 first reported promising effects of GKRS in treating postoperative residual CSH, and since then a growing body of research [6][7][8][9][10][11][12][13][14][15][16][17] has shown that due to its efficacy and extremely low incidence of adverse reac-ABBREVIATIONS CN = cranial nerve; CSH = cavernous sinus hemangioma; GKRS = Gamma Knife radiosurgery.

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“…For giant CSHs (volume > 40 ml, diameter > 4 cm), the main reported treatments were microsurgery [2][3][4][5] and hypofractionated stereotactic radiosurgery, such as Cy-berKnife. [18][19][20] Some research findings have suggested that radiotherapy is effective in treating large (volume > 20 ml) and giant (volume > 40 ml) CSHs. 22,23 There have been few reports on GKRS treatment of giant CSHs.…”

Hypofractionated Stereotactic Radiotherapy with CyberKnife for Large Arteriovenous Malformations and Arteriovenous Malformations Located in Eloquent Areas

“…CyberKnife (CK) is a relatively less-invasive modality among radiosurgical treatments. Hypofractionated stereotactic radiotherapy (HSRT) with CK can reduce radiation toxicity on the surrounding structures with short treatment duration and thus holds a distinguished efficacy for metastatic brain tumors, 1 , 2 ) meningiomas, 3 ) cavernous malformations, 4 ) and small arteriovenous malformations (AVMs). 5 , 6 ) However, it is believed that no reports exist regarding HSRT with CK for AVMs that are difficult to treat (e.g., large AVMs and AVMs located in eloquent areas).…”