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

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 pre-liminary, 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.