Gamma knife radiosurgery for intracranial hemangioblastomas-outcome at 3 years

Faisal T. Sayer, James Nguyen, Robert M. Starke, Chun Po Yen, Jason P. Sheehan

Research output: Contribution to journalReview articlepeer-review

26 Scopus citations

Abstract

Object To define the role of Gamma Knife radiosurgery (GKRS) for the treatment of patients with hemangioblastomas. Methods Between 1992 and 2009, 26 hemangioblastomas in 14 patients (9 female and 5 male) were treated with GKRS. Mean age of patients at the time of treatment was 45.1 years (range 2561). von HippelLindau disease was established in 7 patients, and 7 patients had sporadic hemangioblastomas. Twenty-one tumors were solid, 4 were cystic, and 1 had both components. Four patients were treated with upfront radiosurgery, and 10 were treated following a resection. Mean tumor volume was 1.65 cm3 (range 0.089.02, median 1.1 cm3). Mean dose to the tumor margin was 18 Gy (range 1025, median 18). Patients were assessed clinically and radiologically at 6- to 12-month intervals following GKRS. The median follow-up was 3 years (range 0.512 years). KaplanMeier analysis was used to assess factors predictive of tumor progression, and factors predictive in univariate analysis (P < 0.10) were entered into Cox multivariate regression analysis. Results On follow-up, 4 tumors were stable in volume (15%), 14 decreased (54%), and 8 increased (31%). Local tumor control rates at 1, 5, and 10 years was 89%, 74%, and 50%, respectively. There was a trend toward tumor progression in sporadic patients (P = 0.10), women (P = 0.09), and larger tumors (P = 0.10). In patients with multiple hemangioblastomas as compared to those with only a solitary hemangioblastoma, the radiosurgically treated lesion was 7.9 times more likely to progress after GKRS treatment (P = 0.018). This remained the only significant predictor in multivarialble analysis. At the last clinical follow-up, seven patients showed no change or improvement in their symptoms and seven deteriorated. Conclusion Stereotactic radiosurgery offers a reasonable rate of tumor control and preservation of neurologic function in patients with hemangioblastomas. Patients with multiple hemangioblastomas are less likely to exhibit long-term tumor control of treated lesions following radiosurgery.

Original languageEnglish (US)
Pages (from-to)99-105
Number of pages7
JournalWorld neurosurgery
Volume75
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Keywords

  • Gamma Knife
  • Hemangioblastomas
  • Radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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