Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective international outcome study

Author:

Kano Hideyuki1,Shuto Takashi2,Iwai Yoshiyasu3,Sheehan Jason4,Yamamoto Masaaki5,McBride Heyoung L.6,Sato Mitsuya7,Serizawa Toru8,Yomo Shoji9,Moriki Akihito10,Kohda Yukihiko11,Young Byron12,Suzuki Satoshi13,Kenai Hiroyuki14,Duma Christopher15,Kikuchi Yasuhiro16,Mathieu David17,Akabane Atsuya18,Nagano Osamu19,Kondziolka Douglas20,Lunsford L. Dade1

Affiliation:

1. Departments of Neurological Surgery, University of Pittsburgh, Pennsylvania;

2. Yokohama Rosai Hospital, Yokohama;

3. Osaka City General Hospital, Osaka;

4. University of Virginia, Charlottesville, Virginia;

5. Katsuta Hospital Mito GammaHouse, Hitachinaka;

6. Barrow Neurological Institute, Phoenix, Arizona;

7. Kitanihon Hospital, Gosen;

8. Tsukiji Neurological Clinic, Tokyo;

9. Saitama Gamma Knife Center, Saitama;

10. Mominoki Hospital, Kochi;

11. Asanogawa General Hospital, Kanazawa;

12. University of Kentucky, Lexington, Kentucky;

13. Steel Memorial Yawata Hospital, Kitakyushyu;

14. Nagatomi Neurosurgical Hospital, Oita;

15. Hoag Hospital, Newport Beach, California;

16. Southern Tohoku Hospital, Koriyama;

17. Université de Sherbrooke, Centre de Recherche Clinique Étienne-LeBel, Sherbrooke, Quebec, Canada; and

18. NTT Kanto Hospital, Tokyo;

19. Chiba Cardiovascular Center, Ichihara, Japan;

20. New York University Langone Medical Center, New York, New York

Abstract

OBJECT The purpose of this study was to evaluate the role of stereotactic radiosurgery (SRS) in the management of intracranial hemangioblastomas. METHODS Six participating centers of the North American Gamma Knife Consortium and 13 Japanese Gamma Knife centers identified 186 patients with 517 hemangioblastomas who underwent SRS. Eighty patients had 335 hemangioblastomas associated with von Hippel–Lindau disease (VHL) and 106 patients had 182 sporadic hemangioblastomas. The median target volume was 0.2 cm3 (median diameter 7 mm) in patients with VHL and 0.7 cm3 (median diameter 11 mm) in those with sporadic hemangioblastoma. The median margin dose was 18 Gy in VHL patients and 15 Gy in those with sporadic hemangioblastomas. RESULTS At a median of 5 years (range 0.5–18 years) after treatment, 20 patients had died of intracranial disease progression and 9 patients had died of other causes. The overall survival after SRS was 94% at 3 years, 90% at 5 years, and 74% at 10 years. Factors associated with longer survival included younger age, absence of neurological symptoms, fewer tumors, and higher Karnofsky Performance Status. Thirty-three (41%) of the 80 patients with VHL developed new tumors and 17 (16%) of the106 patients with sporadic hemangioblastoma had recurrences of residual tumor from the original tumor. The 5-year rate of developing a new tumor was 43% for VHL patients, and the 5-year rate of developing a recurrence of residual tumor from the original tumor was 24% for sporadic hemangioblastoma patients. Factors associated with a reduced risk of developing a new tumor or recurrences of residual tumor from the original tumor included younger age, fewer tumors, and sporadic rather than VHL-associated hemangioblastomas. The local tumor control rate for treated tumors was 92% at 3 years, 89% at 5 years, and 79% at 10 years. Factors associated with an improved local tumor control rate included VHL-associated hemangioblastoma, solid tumor, smaller tumor volume, and higher margin dose. Thirteen patients (7%) developed adverse radiation effects (ARE) after SRS, and one of these patients died due to ARE. CONCLUSIONS When either sporadic or VHL-associated tumors were observed to grow on serial imaging studies, SRS provided tumor control in 79%–92% of tumors.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

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