Vol 27, No 1 (2022)
Research paper
Published online: 2022-01-19

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

Jakub Cvek1, Lukas Knybel1, Stefan Reguli2, Radim Lipina2, Pavla Hanzlikova3, Petr Silhan4, Kamila Resova1, Tomas Blazek1, Martin Palicka1, David Feltl5
Rep Pract Oncol Radiother 2022;27(1):134-141.


Background: This retrospective analysis evaluated the long-term outcome of spinal stereotactic body radiotherapy (SBRT) treatment for hemangioblastomas.

Materials and methods: Between 2010 and 2018, 5 patients with 18 Von-Hippel Lindau-related pial-based spinal hemangioblastomas were treated with fractionated SBRT. After precisely registering images of all relevant datasets, we delineated the gross tumor volume, spinal cord (including intramedullary cysts and/or syrinxes), and past radiotherapy regions. A sequential optimization algorithm was used for dose determinations, and patients received 25–26 Gy in five fractions or 24 Gy in three fractions. On-line image guidance, based on spinal bone structures, and two orthogonal radiographs were provided. The actuarial nidus control, surgery-free survival, cyst/syrinx changes, and progression-free survival were calculated with the Kaplan-Meier method. Toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0.

Results: The median follow-up was 5 years after SBRT. Patients displayed one nidus progression, one need of neurosurgery, and two cyst/syrinx progressions directly connected to symptom worsening. No SBRT-related complications or acute adverse radiation-related events occurred. However, one asymptomatic radiological sign of myelopathy occurred two years after SBRT. All tumors regressed; the one-year equivalent tumor volume reduction was 0.2 mL and the median volume significantly decreased by 28% (p = 0.012). Tumor volume reductions were not correlated with the mean (p = 0.19) or maximum (p = 0.16) dose.

Conclusions: SBRT for pial-based spinal hemangioblastomas was an effective, safe, viable alternative to neurosurgery in asymptomatic patients. Escalating doses above the conventional dose-volume limits of spinal cord tolerance showed no additional benefit.


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  1. Qiu J, Cai D, Yang F, et al. Stereotactic radiosurgery for central nervous system hemangioblastoma in von Hippel-Lindau disease: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2020; 195: 105912.
  2. Bridges KJ, Jaboin JJ, Kubicky CD, et al. Stereotactic radiosurgery versus surgical resection for spinal hemangioblastoma: A systematic review. Clin Neurol Neurosurg. 2017; 154: 59–66.
  3. Pan J, Ho AL, D'Astous M, et al. Image-guided stereotactic radiosurgery for treatment of spinal hemangioblastoma. Neurosurg Focus. 2017; 42(1): E12.
  4. Selch MT, Tenn S, Agazaryan N, et al. Image-guided linear accelerator-based spinal radiosurgery for hemangioblastoma. Surg Neurol Int. 2012; 3: 73.
  5. Daly ME, Choi CYH, Gibbs IC, et al. Tolerance of the spinal cord to stereotactic radiosurgery: insights from hemangioblastomas. Int J Radiat Oncol Biol Phys. 2011; 80(1): 213–220.
  6. Chang UK, Rhee CH, Youn SM, et al. Radiosurgery using the Cyberknife for benign spinal tumors: Korea Cancer Center Hospital experience. J Neurooncol. 2011; 101(1): 91–99.
  7. Smalley SR, Schomberg PJ, Earle JD, et al. Radiotherapeutic considerations in the treatment of hemangioblastomas of the central nervous system. Int J Radiat Oncol Biol Phys. 1990; 18(5): 1165–1171.
  8. Kalash R, Glaser SM, Flickinger JC, et al. Stereotactic body radiation therapy for benign spine tumors: is dose de-escalation appropriate? J Neurosurg Spine. 2018; 29(2): 220–225.
  9. Deng X, Wang K, Wu L, et al. Intraspinal hemangioblastomas: analysis of 92 cases in a single institution: clinical article. J Neurosurg Spine. 2014; 21(2): 260–269.
  10. Puataweepong P, Dhanachai M, Hansasuta A, et al. The clinical outcome of intracranial hemangioblastomas treated with linac-based stereotactic radiosurgery and radiotherapy. J Radiat Res. 2014; 55(4): 761–768.
  11. Matsunaga S, Shuto T, Inomori S, et al. Gamma knife radiosurgery for intracranial haemangioblastomas. Acta Neurochir (Wien). 2007; 149(10): 1007–13; discussion 1013.
  12. Mehta GU, Asthagiri AR, Bakhtian KD, et al. Functional outcome after resection of spinal cord hemangioblastomas associated with von Hippel-Lindau disease. J Neurosurg Spine. 2010; 12(3): 233–242.
  13. Liu A, Jain A, Sankey EW, et al. Sporadic intramedullary hemangioblastoma of the spine: a single institutional review of 21 cases. Neurol Res. 2016; 38(3): 205–209.
  14. Chang SD, Meisel JA, Hancock SL, et al. Treatment of hemangioblastomas in von Hippel-Lindau disease with linear accelerator-based radiosurgery. Neurosurgery. 1998; 43(1): 28–34; discussion 34.
  15. Asthagiri AR, Mehta GU, Zach L, et al. Prospective evaluation of radiosurgery for hemangioblastomas in von Hippel-Lindau disease. Neuro Oncol. 2010; 12(1): 80–86.
  16. Moss JM, Choi CYH, Adler JR, et al. Stereotactic radiosurgical treatment of cranial and spinal hemangioblastomas. Neurosurgery. 2009; 65(1): 79–85; discussion 85.
  17. Harati A, Satopää J, Mahler L, et al. Early microsurgical treatment for spinal hemangioblastomas improves outcome in patients with von Hippel-Lindau disease. Surg Neurol Int. 2012; 3: 6.
  18. Kano H, Niranjan A, Mongia S, et al. The role of stereotactic radiosurgery for intracranial hemangioblastomas. Neurosurgery. 2008; 63(3): 443–50; discussion 450.
  19. Kong FMS, Ritter T, Quint DJ, et al. Consideration of dose limits for organs at risk of thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Int J Radiat Oncol Biol Phys. 2011; 81(5): 1442–1457.
  20. Benedict SH, Yenice KM, Followill D, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010; 37(8): 4078–4101.
  21. Koh ES, Nichol A, Millar BA, et al. Role of fractionated external beam radiotherapy in hemangioblastoma of the central nervous system. Int J Radiat Oncol Biol Phys. 2007; 69(5): 1521–1526.