Kano Hideyuki, Niranjan Ajay, Mongia Sanjay, Kondziolka Douglas, Flickinger John C, Lunsford L Dade
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Neurosurgery. 2008 Sep;63(3):443-50; discussion 450-1. doi: 10.1227/01.NEU.0000313120.81565.D7.
To evaluate the role of stereotactic radiosurgery (SRS) in the management of recurrent or residual intracranial hemangioblastomas, we assessed tumor control, survival, and complications in 32 consecutive patients.
We retrospectively reviewed records of 32 consecutive hemangioblastoma patients (74 intracranial tumors) who underwent gamma knife SRS. The median patient age was 43.8 years (range, 21.3-79.4 yr). Thirty-one patients had undergone previous surgical resections. Nineteen patients had sporadic lesions (22 tumors), and 13 patients had von Hippel-Lindau disease-associated hemangioblastomas (52 tumors). The median SRS target volume was 0.72 mL (range, 0.08-16.6 mL), and the median marginal dose was 16.0 Gy (range, 11-20 Gy).
At a median of 50.1 months (range, 6.0-165.4 mo), seven patients had died from disease progression, and one patient had died secondary to heart failure. The overall survival after radiosurgery was 100%, 94.4%, and 68.7% at 1, 3, and 7 years, respectively. Follow-up imaging studies demonstrated tumor control in 68 tumors (91.9%). The progression-free survival after SRS at 1, 3, and 5 years was 96.9%, 95.0%, and 89.9%, respectively. Factors associated with an improved progression-free survival included von Hippel-Lindau disease-associated hemangioblastoma, solid tumor, lower tumor volume, and greater marginal dose.
SRS is an important tool in the management of hemangioblastomas and is associated with a high tumor control rate and a low risk of adverse radiation effects.
为评估立体定向放射外科（SRS）在复发性或残留性颅内血管母细胞瘤治疗中的作用，我们对32例连续患者的肿瘤控制情况、生存率及并发症进行了评估。
我们回顾性分析了32例连续接受伽玛刀SRS治疗的血管母细胞瘤患者（74个颅内肿瘤）的记录。患者中位年龄为43.8岁（范围21.3 - 79.4岁）。31例患者曾接受过手术切除。19例患者有散发性病变（22个肿瘤），13例患者患有与冯·希佩尔 - 林道病相关的血管母细胞瘤（52个肿瘤）。SRS中位靶体积为0.72 mL（范围0.08 - 16.6 mL），中位边缘剂量为16.0 Gy（范围11 - 20 Gy）。
在中位时间50.1个月（范围6.0 - 165.4个月）时，7例患者死于疾病进展，1例患者死于心力衰竭。放射外科治疗后的1年、3年和7年总生存率分别为100%、94.4%和68.7%。随访影像学检查显示68个肿瘤（91.9%）得到肿瘤控制。SRS后的1年、3年和5年无进展生存率分别为96.9%、95.0%和89.9%。与无进展生存率提高相关的因素包括与冯·希佩尔 - 林道病相关的血管母细胞瘤、实体瘤、较小的肿瘤体积和较高的边缘剂量。
SRS是血管母细胞瘤治疗中的重要工具，与高肿瘤控制率和低放射不良反应风险相关。
