Fractionated stereotactic radiotherapy (fSRT) for symptomatic WHO grade 1 cavernous sinus meningiomas: long-term local control, clinical response, and toxicity outcomes

PURPOSE: Cavernous sinus meningiomas represent a significant clinical challenge, given the high prevalence of neurological deficits and limited surgical options. Radiation therapy is often the preferred treatment. This study evaluates the effectiveness of fractionated stereotactic radiation therapy (fSRT) in achieving local control and symptomatic relief in patients with cavernous sinus meningiomas. METHODS: This is a single-institution retrospective analysis of patients with symptomatic presumed WHO grade 1 cavernous sinus meningiomas treated with fSRT (1.8-2 Gy per fraction). Clinical data were collected by chart review. Kaplan-Meier curves were generated to assess local control. Clinical responses were evaluated for symptom improvement, stability, or worsening at ≤ 36 months, 36-60 months, 60-120 months, 120-180 months, and > 180 months. RESULTS: This study identified 39 patients treated with fSRT who met inclusion criteria. Median age was 60 years (range 21-79), with a median Karnofsky Performance Score (KPS) of 90. Median follow-up time was 122.2 months. Median tumor volume was 10.0 cc (range 3.6-18.3 cc). Local control rates at 1, 3, 5, and 10 years were 100%, 94.6%, 91.7%, and 88.1%, respectively. Of 39 patients, 26 (66.7%) demonstrated clinical improvement following fSRT, 9 (23.1%) remained clinically unchanged, and 4 (10.3%) experienced worsening. CONCLUSION: Our study demonstrated fSRT achieves effective local control for cavernous sinus meningioma. Notably, 2/3 of patients achieved neurological symptom improvement after radiation. Larger, prospective studies are warranted to validate these findings.