Stereotactic radiosurgical treatment of cranial and spinal hemangioblastomas

• Published in: Neurosurgery Vol. 65; no. 1; pp. 79 - 85
• Main Authors: Moss, Jason M, Choi, Clara Y H, Adler, Jr, John R, Soltys, Scott G, Gibbs, Iris C, Chang, Steven D
• Format: Journal Article
• Language: English
• Published: United States 01-07-2009
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cranial Nerve Neoplasms - surgery; Female; Follow-Up Studies; Hemangioblastoma - surgery; Humans; Male; Middle Aged; Radiosurgery - methods; Retrospective Studies; Spinal Neoplasms - surgery; Treatment Outcome; von Hippel-Lindau Disease - surgery; Young Adult
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/01.neu.0000348015.51685.d2

Stereotactic radiosurgery has been used for nearly 2 decades to treat hemangioblastomas, particularly those that are in surgically inaccessible locations or that are multiple, as is common in von Hippel-Lindau disease. There is a paucity of long-term published radiosurgical treatment outcomes, particularly for spinal lesions, in a large patient population. The purpose of this study was to provide a long-term retrospective evaluation of radiosurgical hemangioblastoma treatment effectiveness, with a special emphasis on the relatively recent use of frameless, image-guided radiosurgery in the treatment of spinal lesions.
From 1991 to 2007, 92 hemangioblastomas in 31 patients, 26 with von Hippel-Lindau disease, were treated with radiosurgery (27 tumors treated with frame-based linear accelerator radiosurgery, and 67 tumors were treated with CyberKnife radiosurgery). The mean patient age was 41 years (range, 18-81 years). The radiation dose to the tumor periphery averaged 23.4 Gy (range, 12-40 Gy). The mean tumor volume was 1.8 cm (range, 0.058-65.4 cm). Tumor response was evaluated in serial, contrast-enhanced, computed tomographic, and magnetic resonance imaging scans.
Clinical and radiographic follow-up data were available for 82 hemangioblastoma tumors. Only 13 (16%) of the treated hemangioblastomas progressed, whereas 18 tumors (22%) showed radiographic regression, and 51 tumors (62%) remained unchanged in size. With median follow-up of 69 months (range, 5-164 months), the actuarial local control rates at 36 and 60 months were 85% and 82%, respectively. Radiosurgery improved lesion-associated symptoms in 36 of 41 tumors. During the follow-up period, 9 patients died of causes unrelated to the progression of their treated hemangioblastomas, and 5 patients developed radiation necrosis.
Stereotactic radiosurgery is safe and effective in the treatment of hemangioblastomas and is an attractive alternative to surgery for patients, including those with von Hippel-Lindau disease.