Image-guided stereotactic radiosurgery for treatment of spinal hemangioblastoma

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Stereotactic radiosurgery (SRS) has been an attractive treatment option for hemangioblastomas, especially for lesions that are surgically inaccessible and in patients with von Hippel-Lindau (VHL) disease and multiple lesions. Although there has been a multitude of studies examining the utility of SRS in intracranial hemangioblastomas, SRS has only recently been used for spinal hemangioblastomas due to technical limitations. The purpose of this study is to provide a long-term evaluation of the effectiveness of image-guided radiosurgery in halting tumor progression and providing symptomatic relief for spinal hemangioblastomas.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Between 2001 and 2011, 46 spinal hemangioblastomas in 28 patients were treated using the CyberKnife image-guided radiosurgery system at the authors' institution. Fourteen of these patients also had VHL disease. The median age at treatment was 43.5 years (range 19–85 years). The mean prescription radiation dose to the tumor periphery was 21.6 Gy (range 15–35 Gy). The median tumor volume was 0.264 cm<jats:sup>3</jats:sup> (range 0.025–70.9 cm<jats:sup>3</jats:sup>). Tumor response was evaluated on serial, contrast-enhanced CT and MR images. Clinical response was evaluated by clinical and imaging evaluation.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The mean follow-up for the cohort was 54.3 months. Radiographic follow-up was available for 19 patients with 34 tumors; 32 (94.1%) tumors were radiographically stable or displayed signs of regression. Actuarial control rates at 1, 3, and 5 years were 96.1%, 92.3%, and 92.3%, respectively. Clinical evaluation on follow-up was available for 13 patients with 16 tumors; 13 (81.2%) tumors in 10 patients had symptomatic improvement. No patient developed any complications related to radiosurgery.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Image-guided SRS is safe and effective for the primary treatment of spinal hemangioblastomas and is an attractive alternative to resection, especially for those with VHL disease.</jats:p></jats:sec>

Updates in the management of intradural spinal cord tumors: a radiation oncology focus

“…Spine SRS series have been very encouraging given the high rates of disease control (often exceeding 90%), improvements in disease-related neurologic symptoms, and lack of significant adverse toxicity, although patient selection is key to appropriate triage of patients for SRS and a discussion with respect to radiation injury to the spinal cord associated with the high dose per fraction inherent to spine SRS. 72,73 It is important to note that in the radiotherapy experience for intracranial hemangioblastomas, local control rates appear to be higher in VHL-associated disease compared with sporadic cases and likely the same would be true in the spine. 71,74,75 Very robust patient immobilization and accurate target volume visualization and delineation are critical to planning spine SRS for patients with hemangioblastoma, and MR images are co-registered to the treatment planning CT scans to delineate the disease (the enhancing nodule, without the associated cyst), spinal cord, and other nearby organs-at-risk.…”

“…Patients can be treated with a variety of radiosurgery platforms and the prescription dose in the literature ranges 16-20 Gy based on spinal cord tolerance. 72,73,76,77 Adverse neurologic events after radiosurgery have been reported, but serious toxicities occur very rarely following treatment. 71,73,77…”

Posterior approach for anteriorly located cervical spinal cord hemangioblastomas: technical note

“…4 Studies on the treatment of these lesions with the use of radiosurgery have been published with differing results, but the gold standard remains microsurgical resection. 8 The goal of surgery is a total resection without causing a new neurological deficit. Despite all the advances in the neurosurgical armamentarium, this remains challenging when operating in the anterior spinal cord.…”

Combined Microsurgery and Radiotherapy for Multiple Spinal Cord Hemangioblastomas with Holocord Syrinx in von Hippel-Lindau Disease: A Case Report

“…Although surgical resection constitutes the therapy of choice for spinal HABs, radiotherapy has become increasingly important for the treatment of surgically not amenable lesions in both cranial and spinal locations. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22…”