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Introduction: Cavernous sinus hemangiomas are rare complex vascular tumors which are a challenge to manage. Large tumors are often incompletely removed and require surveillance or adjuvant radiotherapy. We report a case of a large cavernous sinus hemangioma with orbital apex involvement treated solely with SRT with rapid reversal of visual symptoms within 2 weeks of treatment with opthamologist documentation pre, during and post treatment. Material and Methods: A 74 year-old lady presented with a 1-year history of gradually worsening left eye vision, 2-month history of left partial ptosis and occasional left cheek numbness. Ophthalmic examination revealed only perception of hand motion in the left eye, left relative afferent papillary defect and an obvious left eye ptosis. MRI showed a lobulated 3.4x2.6x1.9cm mass in the left cavernous sinus with extension into the right cavernous sinus, left orbital apex and was associated with left optic nerve compression. The lesion was hypo-intense on T1 imaging, with homogenous T2W hyperintensity and gadolinium enhancement. Neuroradiological conference reported these to be consistent with a cavernous sinus haemangioma. Patient was immobilsed and simulated according to protocol. The lesion was contoured on 1mm gadolinuim-enhanced T1W MRI images and 1mm margin was given to form the PTV. The plan was designed using 11 non-co-planar beams, 45Gy in 25 fractions of 1.8Gy over 5 weeks was prescribed to the 95% isodose line. The PTV was 28.337cc and the treated volume was 36.184cc giving a conformity index of 1.32. All critical structures were well within their tolerance. Results: At her 2nd week review, the patient reported dramatic left eye vision improvement. Formal ophthalmic examination showed improvement of left-sided visual acuity to 6/12 (pinhole) along with a left-sided grade 2 relative afferent pupillary defect (RAPD). Visual fields were normal by red dot testing. She completed her SRT uneventfully and at 1 month post-treatment, her ptosis had resolved and visual symptoms remained stable. Repeat opthamologic examination at 3 and 6 months post-treatment remained stable. MRI at 6 months post-treatment showed a volume reduction of 30%. Conclusion: Visual improvement has been reported in the literature following SRS/FSRT for cavernous-orbital hemangiomas at 3-6 months. To the best of our knowledge, this is the first case that showed rapid intra-treatment reversal that was confirmed by specialist ophthalmologic assessment. SRT is an effective and safe therapeutic option for large cavernous sinus hemangiomas, which shows great potential. Larger series and longer term follow-up is required to confirm this. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]