The role of stereotactic radiosurgery for intracranial hemangioblastomas
Hideyuki Kano1, Ajay Niranjan, Sanjay Mongia
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Objective:
To evaluate the role of stereotactic radiosurgery (SRS) in the management of recurrent or residual intracranial hemangioblastomas, we assessed tumor control, survival, and complications in 32 consecutive patients.
Methods:
We retrospectively reviewed records of 32 consecutive hemangioblastoma patients (74 intracranial tumors) who underwent gamma knife SRS. The median patient age was 43.8 years (range, 21.3-79.4 yr). Thirty-one patients had undergone previous surgical resections. Nineteen patients had sporadic lesions (22 tumors), and 13 patients had von Hippel-Lindau disease-associated hemangioblastomas (52 tumors). The median SRS target volume was 0.72 mL (range, 0.08-16.6 mL), and the median marginal dose was 16.0 Gy (range, 11-20 Gy).
Results:
At a median of 50.1 months (range, 6.0-165.4 mo), seven patients had died from disease progression, and one patient had died secondary to heart failure. The overall survival after radiosurgery was 100%, 94.4%, and 68.7% at 1, 3, and 7 years, respectively. Follow-up imaging studies demonstrated tumor control in 68 tumors (91.9%). The progression-free survival after SRS at 1, 3, and 5 years was 96.9%, 95.0%, and 89.9%, respectively. Factors associated with an improved progression-free survival included von Hippel-Lindau disease-associated hemangioblastoma, solid tumor, lower tumor volume, and greater marginal dose.
Conclusion:
SRS is an important tool in the management of hemangioblastomas and is associated with a high tumor control rate and a low risk of adverse radiation effects.