Selch Michael T, Tenn Steve, Agazaryan Nzhde, Lee Steve P, Gorgulho Alessandra, De Salles Antonio A F
Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Surg Neurol Int. 2012;3:73. doi: 10.4103/2152-7806.98386. Epub 2012 Jul 14.
To retrospectively review the efficacy and safety of image-guided linear accelerator-based radiosurgery for spinal hemangioblastomas.
Between August 2004 and September 2010, nine patients with 20 hemangioblastomas underwent spinal radiosurgery. Five patients had von Hipple-Lindau disease. Four patients had multiple tumors. Ten tumors were located in the thoracic spine, eight in the cervical spine, and two in the lumbar spine. Tumor volume varied from 0.08 to 14.4 cc (median 0.72 cc). Maximum tumor dimension varied from 2.5 to 24 mm (median 10.5 mm). Radiosurgery was performed with a dedicated 6 MV linear accelerator equipped with a micro-multileaf collimator. Median peripheral tumor dose and prescription isodose were 12 Gy and 90%, respectively. Image guidance was performed by optical tracking of infrared reflectors, fusion of oblique radiographs with dynamically reconstructed digital radiographs, and automatic patient positioning. Follow-up varied from 14 to 86 months (median 51 months).
Kaplan-Meier estimated 4-year overall and solid tumor local control rates were 90% and 95%, respectively. One tumor progressed 12 months after treatment and a new cyst developed 10 months after treatment in another tumor. There has been no clinical or imaging evidence for spinal cord injury.
Results of this limited experience indicate linear accelerator-based radiosurgery is safe and effective for spinal cord hemangioblastomas. Longer follow-up is necessary to confirm the durability of tumor control, but these initial results imply linear accelerator-based radiosurgery may represent a therapeutic alternative to surgery for selected patients with spinal hemangioblastomas.
回顾性分析基于图像引导的直线加速器放射外科治疗脊髓血管母细胞瘤的疗效和安全性。
2004年8月至2010年9月，9例患者共20个血管母细胞瘤接受了脊髓放射外科治疗。5例患者患有冯·希佩尔-林道病。4例患者有多个肿瘤。10个肿瘤位于胸椎，8个位于颈椎，2个位于腰椎。肿瘤体积从0.08至14.4立方厘米不等（中位数为0.72立方厘米）。肿瘤最大直径从2.5至24毫米不等（中位数为10.5毫米）。使用配备微型多叶准直器的专用6兆伏直线加速器进行放射外科治疗。肿瘤周边剂量中位数和处方等剂量分别为12 Gy和90%。通过红外反射器的光学跟踪、斜位X线片与动态重建数字X线片的融合以及患者自动定位进行图像引导。随访时间从14至86个月不等（中位数为51个月）。
Kaplan-Meier法估计4年总生存率和实体肿瘤局部控制率分别为90%和95%。1个肿瘤在治疗后12个月进展，另1个肿瘤在治疗后10个月出现新囊肿。没有脊髓损伤的临床或影像学证据。
这一有限经验的结果表明，基于直线加速器的放射外科治疗脊髓血管母细胞瘤是安全有效的。需要更长时间的随访来确认肿瘤控制的持久性，但这些初步结果表明，基于直线加速器的放射外科治疗可能是部分脊髓血管母细胞瘤患者手术治疗的替代方案。
