Stereotactic radiosurgery in the management of central nervous system hemangioblastomas: a systematic review and...

Central nervous system (CNS) hemangioblastomas are rare, benign vascular tumors occurring sporadically or with von Hippel-Lindau (VHL) disease. While resection remains the primary treatment for symptomatic lesions, stereotactic radiosurgery (SRS) has emerged as an alternative where surgery is not feasible. This research aims to investigate the efficacy and safety of SRS for CNS hemangioblastomas, focusing on long-term outcomes and identifying key prognostic factors. A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library till October 4th, 2024. Studies investigating the efficacy of SRS for CNS hemangioblastomas were included. The risk of bias was assessed using the ROBINS-I tool. Meta-analysis, subgroup analysis, and meta-regression were performed using the R programming language. A total of 28 studies with 627 patients and 1761 lesions were included. Our meta-analysis demonstrated pooled overall, 5- and 10-year local tumor control rates of 89% (95% CI: 85-92%), 87% (95% CI: 82-91%), and 80% (95% CI: 63-91%), respectively. Tumor response assessment revealed that 28% (95% CI: 19-40%) of lesions had regression, while 59% (95% CI: 46-70%) remained stable. VHL-associated lesions had a higher control than sporadic tumors at the 5-year follow-up (VHL: 94% (95% CI: 90-97%) vs. Sporadic: 82% (95% CI: 76-86%), P < 0.01). Pooled adverse events were 11% (95% CI: 8-15%). Meta-regression identified the female sex as a positive predictor for tumor control and lower adverse event rate (P < 0.01 and P = 0.02, respectively), while higher marginal and maximum radiation doses correlated with increased adverse events (P = 0.02 and P = 0.03, respectively). SRS represents a reasonably effective and safe treatment option for CNS hemangioblastomas, particularly in VHL-associated lesions. Patient demographics, VHL status, and tumor characteristics have been analyzed to identify factors potentially impacting treatment outcomes.