Hideyuki Kano1, Takashi Shuto2, Yoshiyasu Iwai3, Jason Sheehan4, Masaaki Yamamoto5, Heyoung L McBride6, Mitsuya Sato7, Toru Serizawa8, Shoji Yomo9, Akihito Moriki10, Yukihiko Kohda11, Byron Young12, Satoshi Suzuki13, Hiroyuki Kenai14, Christopher Duma15, Yasuhiro Kikuchi16, David Mathieu17, Atsuya Akabane18, Osamu Nagano19, Douglas Kondziolka20, L Dade Lunsford1. 1. Departments of 1Neurological Surgery, University of Pittsburgh, Pennsylvania; 2. 2Yokohama Rosai Hospital, Yokohama; 3. 3Osaka City General Hospital, Osaka; 4. 4University of Virginia, Charlottesville, Virginia; 5. 5Katsuta Hospital Mito GammaHouse, Hitachinaka; 6. 6Barrow Neurological Institute, Phoenix, Arizona; 7. 7Kitanihon Hospital, Gosen; 8. 8Tsukiji Neurological Clinic, Tokyo; 9. 9Saitama Gamma Knife Center, Saitama; 10. 10Mominoki Hospital, Kochi; 11. 11Asanogawa General Hospital, Kanazawa; 12. 12University of Kentucky, Lexington, Kentucky; 13. 13Steel Memorial Yawata Hospital, Kitakyushyu; 14. 14Nagatomi Neurosurgical Hospital, Oita; 15. 15Hoag Hospital, Newport Beach, California; 16. 16Southern Tohoku Hospital, Koriyama; 17. 17Université de Sherbrooke, Centre de Recherche Clinique Étienne-LeBel, Sherbrooke, Quebec, Canada; and. 18. 18NTT Kanto Hospital, Tokyo; 19. 19Chiba Cardiovascular Center, Ichihara, Japan; 20. 20New 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 cm(3) (median diameter 7 mm) in patients with VHL and 0.7 cm(3) (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.
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 cm(3) (median diameter 7 mm) in patients with VHL and 0.7 cm(3) (median diameter 11 mm) in those with sporadic hemangioblastoma. The median margin dose was 18 Gy in VHLpatients 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 VHLpatients, and the 5-year rate of developing a recurrence of residual tumor from the original tumor was 24% for sporadic hemangioblastomapatients. 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.
Entities:
Keywords:
ARE = adverse radiation effects; Gamma Knife; KPS = Karnofsky Performance Status; NAGKC = North American Gamma Knife Consortium; SRS = stereotactic radiosurgery; UPMC = University of Pittsburgh Medical Center; UVA = University of Virginia; VHL = von Hippel–Lindau disease; hemangioblastoma; stereotactic radiosurgery; von Hippel–Lindau disease
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