Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective international outcome study
| Autor: | Atsuya Akabane, David Mathieu, Toru Serizawa, Hideyuki Kano, Yoshiyasu Iwai, Douglas Kondziolka, Yukihiko Kohda, Jason P. Sheehan, Christopher Duma, Satoshi O. Suzuki, Akihito Moriki, Osamu Nagano, Byron Young, Heyoung McBride, Takashi Shuto, Hiroyuki Kenai, Mitsuya Sato, L. Dade Lunsford, Shoji Yomo, Yasuhiro Kikuchi, Masaaki Yamamoto |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty von Hippel-Lindau Disease Adolescent medicine.medical_treatment Planning target volume Gamma knife Radiosurgery Young Adult Hemangioblastoma Outcome Assessment Health Care medicine Humans In patient Von Hippel–Lindau disease Aged Retrospective Studies Aged 80 and over business.industry Brain Neoplasms Disease progression Retrospective cohort study Middle Aged medicine.disease Surgery Treatment Outcome Disease Progression Female Neoplasm Recurrence Local business |
| Zdroj: | Journal of neurosurgery. 122(6) |
| ISSN: | 1933-0693 |
| Popis: | 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 cm3 (median diameter 7 mm) in patients with VHL and 0.7 cm3 (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. |
| Databáze: | OpenAIRE |
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