Evaluation Of The Efficacy Of Stereotactic Radiotherapy For Cavernous Sinus Hemangioma

Objective:The literatures of cavernous sinus hemangioma(CSHs)treated with stereotactic radiotherapy are received and the data is analyzed to evaluate the efficacy and safety of stereotactic radiosurgery as the treatment of cavernous sinus hemangioma,so as to provide theoretical basis for the selection of clinical treatment.Methods:Search the database such as Pub Med,Medline,Embase,OVID to extract the data that meet the inclusion criteria.The inclusion criterias of the cavernous sinus literature are that the follow-up information is open,and provide specific information for every patient(age,gender,clinical symptoms and the tumor volume,radiotherapy dose,follow-up time,tumor control and symptom improvement,etc.)and are written with English.There are 7 articles selected,in which 6 articles are about the Gamma knife treatment and 1 article is about Cyber knife treatment.Organize the information of 131 cases of cavernous sinus hemangioma patients(40 males,91 females,the average age is51.8 years old,the age ranged from 19 to 80 years),including 27 patients were confirmed by biopsy,104 cases were confirmed by image examination.There are 117 patients received Gamma knife treatment and 14 cases received Cyber knife treatment in all 131 patients.The range of tumor volume is 0.3 ~ 96.3cm3,the average is(20.98±21.34)cm3.Results:The average follow-up time is 38 months(6 to 164 months),the last follow-up MRI show that in 4 cases(3.1%)the tumor disappeared,in 95 cases(72.5%)the tumor is significantly reduced,in 22 cases(16.8%)the tumor is partially reduced and in 10 cases(7.6%)the tumor has no change.Extracting the data from the literature and statistical analysis shows that there are significant differences between the patients that tumor was significantly reduced or disappeared and the patients that tumors reduced or no changes in the marginal radiation dose(P=0.044).There are significant differences between patients accept surgery before radiotherepy and those who do not in recovery of neurological symptoms(P < 0.001).There is no significant difference between the patients accepted surgical treatment before radiotherapy and the patients accepted radiotherapy as the primary treatment in the the degree of volume reduction(P=0.171).There are significant differences in curative effect between the Cyber knife and Gamma knife for giant cavernous sinus hemangioma(P=0.041),and the curative effect of Cyber knife fractionated radiotherapy is better than Gamma knife.No new neurologic symptoms are found in all patients.Conclusion:Stereotactic radiotherapy can effectively avoid the complications of surgical and interventional embolization during the follow-up period,can reduce tumor volume and improve neurological symptoms availably,and can be chosen as the main treatment for cavernous sinus hemangioma,but the long-term efficacy needs further study.Cyber knife fractionated radiotherapy is an effective treatment for giant cavernous sinus hemangioma,the curative effect is obviously better than the Gamma knife radiotherapy.This paper is a study on evaluation of non random observational results based on limited non randomized study,may be affected by bias or confounding factors,and needs further random research.