Stereotactic radiosurgery for hypervascular intracranial tumors

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Hypervascular tumors like central neurocytomas (CNCs), cavernous sinus hemangiomas (CSHs), and glomus tumors (GTs) pose treatment challenges.
• Stereotactic radiosurgery (SRS) is an option for managing these complex lesions.

Purpose of the Study:

• To assess the safety and efficacy of SRS for CNCs, CSHs, and GTs.
• To compare upfront SRS versus adjuvant SRS in treating these hypervascular tumors.

Main Methods:

• Retrospective review of 60 hypervascular tumors (28 CNCs, 16 CSHs, 16 GTs) treated with SRS between 1993 and 2017.
• Tumor response evaluated via volumetric magnetic resonance imaging analysis.
• Categorization of tumor response: regression (>10% decrease), stable (≤10% change), or progression (>10% increase) in tumor volume (TV).

Main Results:

• 90% of tumors showed regression after initial SRS, with significant relative TV reductions observed over time for all tumor types.
• CSHs demonstrated the most substantial volume reduction (88% at 48 months), followed by CNCs (73% at 48 months) and GTs (47% at 48 months).
• Upfront SRS (43% of cases) yielded comparable TV reductions to adjuvant SRS, with only five patients experiencing adverse radiation effects and no mortality.

Conclusions:

• SRS is a safe and effective treatment for hypervascular tumors, achieving high regression rates and low complication risks.
• No significant difference in tumor volume reduction was observed between upfront and adjuvant SRS strategies.
• Upfront SRS can be considered a viable treatment option for select patients with these tumors.