Cyberknife Stereotactic Radiosurgery for Cranial and Spinal Hemangioblastomas: A Single-institution Experience

Introduction: Hemangioblastomas are relatively rare vascular neoplasms that typically occur in the posterior fossa; either as sporadic lesions or as manifestations of von Hippel-Lindau disease (VHL). Stereotactic radiosurgery (SRS) has been an attractive treatment option for lesions in critical locations or multiple lesions commonly associated with von Hippel-Lindau (VHL) disease. This study aims to present a long-term retrospective evaluation of treatment effectiveness of CyberKnife radiosurgery for hemangioblastomas following treatment with SRS as the largest single-institution experience.

Methods: We retrospectively reviewed the clinical and radiological outcomes of patients with histopathologically confirmed hemangioblastomas treated with CyberKnife SRS at our institute from 1998 to 2022. Clinical and radiographic follow-up data were available for a total of 135 hemangioblastomas in 35 patients. Twenty-eight patients had 123 hemangioblastomas associated with VHL and 7 had 12 sporadic hemangioblastomas. The median age at the time of SRS was 36 years (range: 18–82), the median marginal dose was 21 Gy (range: 14–30), and the median tumor volume was 0.4 cc (range: 0.02-36.4).

Results: At a median of 5 years (range: 0.3-21.7) after treatment, only 20 (16.2%) of the VHL-associated and 1 (8.3%) sporadic hemangioblastomas progressed, 14 (11.4%) VHL-related and 1 (8.3%) sporadic hemangioblastomas exhibited radiographic regression, and 89 (72.3%) VHL-associated and 10 (83.3%) sporadic lesions remained stable in volume. The 5-year local tumor control (LTC) rate was 92.4% for all hemangioblastomas, 92.3% among the VHL-related, and 90.9% among the sporadic lesions. SRS improved tumor-associated symptoms in 28 patients (84.8%), including headaches, neck pain, dizziness, ataxia, and dysesthesia. During the period of follow-up, 2 patients developed radiation necrosis, while 1 of them required surgical resection.

Conclusion : CyberKnife SRS is a safe and effective treatment option for patients with both cranial and spinal hemangioblastomas and serves as an attractive alternative to surgical resection for inaccessible tumors or multiple lesions in a long-term manner.