Radiation therapy for symptomatic vertebral haemangioma

Vertebral haemangiomas are slowly growing benign tumours and are usually asymptomatic. They rarely cause symptoms and signs related to cord compression. Larger lesions create significant problems during surgery because of haemorrhage and vascular supply crucial to spinal cord function. In such severely symptomatic vertebral haemangiomas, radiation therapy has been tried and good results obtained, especially in terms of good functional recovery. We have treated 17 patients (including nine paraplegic patients) with radiotherapy (Co-60). Treatment was given by single posterior field, encompassing the involved area with a dose of 35-40 Gy in 3 to 4 weeks (five fractions per week). All patients with pain and tenderness were relieved completely (87.5%) or partially (12.5%). Similarly patients with numbness and paresis showed either complete (66.7%) or partial response (33.3%) from symptoms on follow-up. Out of nine paraplegic patients six (66.6%) had recovered completely, one (11.2%) partially and two (22.2%) had no response. The two patients who did not show any marked relief, had paraplegia of longer duration (more than 6 months). Our study indicates that severely symptomatic vertebral haemangioma can be successfully treated by radiation therapy and it can be chosen as first line of treatment with an optimum dose of 35-40 Gy in 3 to 4 weeks.