Stereotactic radiosurgery for hemangioblastomas of the brain

Objective. To assess the effectiveness of stereotactic radiosurgery in achieving tumor control and improving survival in patients with hemangioblastoma, we evaluated results from patients who were managed at the University of Pittsburgh and the Mayo Clinic. Patients and Methods. Twenty-seven patients with 29 hemangioblastomas had stereotactic radiosurgery over a 10 year interval. The mean patient age was 32 years (range, 14-75 years). The tumor volumes varied from 0.36 to 27 ml (mean, 3.2 ml), and the mean tumor margin dose was 16 Gy (range, 11.7-20). Clinical and neuroimaging follow-up was obtained for all patients between 0.5 and 9 years (mean, 4 years) after radiosurgery. Results. At this assessment, 21 patients (79%) were alive and six (21%) had died. The median survival after radiosurgery was 6.5 years (actuarial 5 year survival = 75.1 ± 11.5%). The median survival from the initial diagnosis was 15 years. Twenty two of 29 evaluable tumors were controlled locally. The two-year actuarial control rate was 84.5 ± 7.1% and at five years, 75.2 ± 8.9%. Multivariate testing of factors affecting good outcome indicated that smaller tumor volume and higher radiosurgical dose (> 18 Gy) were significant. Conclusion. For small to moderate size hemangioblastomas, multiple or recurrent tumors, and for patients who are not surgical candidates, radiosurgery is a safe and effective option to control disease and improve survival.