Stereotactic radiotherapy for spinal hemangioblastoma — disease control and volume analysis in long-term follow up

Abstract

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Stereotactic Radiosurgery for Spinal Haemangioblastoma: A Retrospective Single-Centre Experience from the United Kingdom

“…Our doses were most similar to Selch et al [5] who used a median prescribed dose of 12 Gy to the 90% isodose and also employed a 2 mm GTV to PTV margin. Other authors used significantly higher doses, ranging from 13 to 25 Gy in a single fraction [14,16,17] and 18-33 Gy in 2-5 fractions [13,16,17,20]. The mean prescription isodose was similar among studies and ranged between 68 and 100% [9,10,14,17].…”

“…This study presents the initial data for the use of SRS in spinal haemangioblastoma from the United Kingdom. The previously published literature for spinal SRS is mainly limited to case series and case reports from Asia, the Czech Republic, and North America [5,9,10,[13][14][15][16][17][18][19][20]. One meta-analysis has been published and reported a pooled 5-year PFS of 90.42% ((95% CI): 82.74-98.10%) following SRS [1]; however, this was derived from only three studies [5,9,17], two of which are from the same institution.…”

“…Among the studies reviewed, the 1-, 3-, 4-and 5-year PFS was estimated at 96.1% [9], 86-92.3% [9,10,17], 95% [5] and 92-92.3% [9,10], respectively. In studies which did not calculate PFS, tumours were stable or had regressed in between 87.5% and 100% of cases at a median follow-up of 13.5-60 months [13,14,16,20]. This is similar to previously reported radiological outcomes with SRS for intracranial haemangioblastoma, with a pooled 5-year PFS of 88.44% (95% CI: 85.26-91.62%, I 2 = 0%) in a meta-analysis of 12 studies [1].…”

“…Similar to our study, Selch et al [5] included ≥95% of the target volume within the prescription isodose line, and in all tumours, the spinal cord D max was <12 Gy. Cvek et al [20] also maintained ≥95% target volume coverage but used a significantly higher median prescribed fractionated dose of 28.6 Gy and a median spinal cord D max of 26.3 Gy yet reported no late radiation-related toxicity. Future studies should also report SRS target volume coverage, to enable better comparison of SRS prescription doses.…”

“…In the study by Pan et al [9], radiological evaluation was determined by the patients' treating physician. Cvek et al [20] defined progression as enlargement in any dimension on MRI imaging. In other studies, no definition of progression was specified [10,13,14,16,17].…”