Abstract
Purpose/Objective: Hemangioblastoma is a primary solid or cystic vascular tumor of the central nervous system that occurs most frequently in the cerebellum, brain stem and spinal cord. Between June 1988 and June 1994, 38 hemangioblastomas were treated with stereotactic radiosurgery (SR) at 3 active SR centers in order to evaluate the efficacy and potential toxicity of this therapeutic modality as an adjuvant or alternative treatment to surgical resection. Materials and Methods: SR was performed using either a 201-cobalt source Gamma Knife unit or a dedicated SR linear accelerator. Of the 18 primary tumors treated, 16 had no prior history of surgical resection and were treated definitively with SR and 2 primary lesions were subtotally resected and subsequently treated with SR. Twenty lesions were treated with SR after prior surgical failure (17 tumors) or failure after prior surgery and conventional radiotherapy (3 tumors). Eight patients were treated with SR for multifocal disease (total, 24 known tumors). SR tumor volumes measured 0.05 to 12 cc (median, 0.97 cc). Minimum tumor doses ranged from 12 to 20 Gy (median, 15.5 Gy). Results: Median follow-up from the time of SR was 24.5 months (range, 6 to 77 months). The 2-year actuarial overall survival was
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Citation Formats
Patrice, Stephen J, Sneed, Penny K, Flickinger, John C, Alexander, Eben, Larson, David A, Shrieve, Dennis C, Pollock, Bruce E, Kondziolka, Douglas S, Gutin, Philip H, Wara, William M, McDermott, Michael W, Lunsford, L Dade, and Loeffler, Jay S.
Radiosurgery for hemangioblastoma: results of a multi-institutional experience.
United States: N. p.,
1995.
Web.
doi:10.1016/0360-3016(95)97676-R.
Patrice, Stephen J, Sneed, Penny K, Flickinger, John C, Alexander, Eben, Larson, David A, Shrieve, Dennis C, Pollock, Bruce E, Kondziolka, Douglas S, Gutin, Philip H, Wara, William M, McDermott, Michael W, Lunsford, L Dade, & Loeffler, Jay S.
Radiosurgery for hemangioblastoma: results of a multi-institutional experience.
United States.
https://doi.org/10.1016/0360-3016(95)97676-R
Patrice, Stephen J, Sneed, Penny K, Flickinger, John C, Alexander, Eben, Larson, David A, Shrieve, Dennis C, Pollock, Bruce E, Kondziolka, Douglas S, Gutin, Philip H, Wara, William M, McDermott, Michael W, Lunsford, L Dade, and Loeffler, Jay S.
1995.
"Radiosurgery for hemangioblastoma: results of a multi-institutional experience."
United States.
https://doi.org/10.1016/0360-3016(95)97676-R.
@misc{etde_20391356,
title = {Radiosurgery for hemangioblastoma: results of a multi-institutional experience}
author = {Patrice, Stephen J, Sneed, Penny K, Flickinger, John C, Alexander, Eben, Larson, David A, Shrieve, Dennis C, Pollock, Bruce E, Kondziolka, Douglas S, Gutin, Philip H, Wara, William M, McDermott, Michael W, Lunsford, L Dade, and Loeffler, Jay S}
abstractNote = {Purpose/Objective: Hemangioblastoma is a primary solid or cystic vascular tumor of the central nervous system that occurs most frequently in the cerebellum, brain stem and spinal cord. Between June 1988 and June 1994, 38 hemangioblastomas were treated with stereotactic radiosurgery (SR) at 3 active SR centers in order to evaluate the efficacy and potential toxicity of this therapeutic modality as an adjuvant or alternative treatment to surgical resection. Materials and Methods: SR was performed using either a 201-cobalt source Gamma Knife unit or a dedicated SR linear accelerator. Of the 18 primary tumors treated, 16 had no prior history of surgical resection and were treated definitively with SR and 2 primary lesions were subtotally resected and subsequently treated with SR. Twenty lesions were treated with SR after prior surgical failure (17 tumors) or failure after prior surgery and conventional radiotherapy (3 tumors). Eight patients were treated with SR for multifocal disease (total, 24 known tumors). SR tumor volumes measured 0.05 to 12 cc (median, 0.97 cc). Minimum tumor doses ranged from 12 to 20 Gy (median, 15.5 Gy). Results: Median follow-up from the time of SR was 24.5 months (range, 6 to 77 months). The 2-year actuarial overall survival was 88% +/- 15% (95% confidence interval). To date, 4 of the 22 patients in the study have died. Of these 4 patients, 2 who received SR for salvage of surgical failure died of progressive intracranial tumor, 1 died of metastatic breast carcinoma, and 1 died of renal failure as a result of systemic complications of von Hippel-Lindau Syndrome (VHL). Three-year actuarial freedom from progression was 86% +/- 12% (95% confidence interval). Thirty-one of the 36 evaluable tumors (86%) were controlled locally. None of the 18 primary tumors that were treated with SR as definitive therapy have failed to date. All 5 lesions that ultimately failed to be controlled by SR were recurrent tumors that had been treated with SR for salvage of initial surgical failure. Thirteen of the 18 evaluable recurrent tumors (72%) were therefore controlled as of last follow-up. The median tumor volume of the lesions that failed to be controlled by SR was 7.85 cc (range, 3.20 to 10.53 cc) compared to 0.67 cc (range, 0.05 to 12 cc) for controlled lesions (p = 0.0023). The lesions that failed to be controlled by SR received a median minimum tumor dose of 14 Gy (range, 13 to 17 Gy) compared to 16 Gy (range, 12 to 20 Gy) for controlled lesions (p = 0.0239). Seventy-eight percent of the surviving patients remained neurologically stable or clinically improved. There were no significant permanent complications directly attributable to SR. Conclusion: This report documents the largest experience in the literature of the use of SR in the treatment of hemangioblastoma. We conclude that SR: 1) controls the majority of primary and recurrent hemangioblastomas; 2) offers the ability to treat multiple lesions in a single treatment session which is particularly important for patients with VHL; and that 3) better control rates are associated with higher doses and smaller tumor volumes. We believe that SR will play an increasingly important role as a non-invasive alternative therapeutic modality for hemangioblastoma and recommend its use in the following clinical situations: 1) surgically unresectable disease; 2) as adjuvant treatment for subtotally resected disease; 3) as definitive treatment of multifocal disease; and 4) as salvage therapy for radiographically discrete recurrences after surgical failure.}
doi = {10.1016/0360-3016(95)97676-R}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}
title = {Radiosurgery for hemangioblastoma: results of a multi-institutional experience}
author = {Patrice, Stephen J, Sneed, Penny K, Flickinger, John C, Alexander, Eben, Larson, David A, Shrieve, Dennis C, Pollock, Bruce E, Kondziolka, Douglas S, Gutin, Philip H, Wara, William M, McDermott, Michael W, Lunsford, L Dade, and Loeffler, Jay S}
abstractNote = {Purpose/Objective: Hemangioblastoma is a primary solid or cystic vascular tumor of the central nervous system that occurs most frequently in the cerebellum, brain stem and spinal cord. Between June 1988 and June 1994, 38 hemangioblastomas were treated with stereotactic radiosurgery (SR) at 3 active SR centers in order to evaluate the efficacy and potential toxicity of this therapeutic modality as an adjuvant or alternative treatment to surgical resection. Materials and Methods: SR was performed using either a 201-cobalt source Gamma Knife unit or a dedicated SR linear accelerator. Of the 18 primary tumors treated, 16 had no prior history of surgical resection and were treated definitively with SR and 2 primary lesions were subtotally resected and subsequently treated with SR. Twenty lesions were treated with SR after prior surgical failure (17 tumors) or failure after prior surgery and conventional radiotherapy (3 tumors). Eight patients were treated with SR for multifocal disease (total, 24 known tumors). SR tumor volumes measured 0.05 to 12 cc (median, 0.97 cc). Minimum tumor doses ranged from 12 to 20 Gy (median, 15.5 Gy). Results: Median follow-up from the time of SR was 24.5 months (range, 6 to 77 months). The 2-year actuarial overall survival was 88% +/- 15% (95% confidence interval). To date, 4 of the 22 patients in the study have died. Of these 4 patients, 2 who received SR for salvage of surgical failure died of progressive intracranial tumor, 1 died of metastatic breast carcinoma, and 1 died of renal failure as a result of systemic complications of von Hippel-Lindau Syndrome (VHL). Three-year actuarial freedom from progression was 86% +/- 12% (95% confidence interval). Thirty-one of the 36 evaluable tumors (86%) were controlled locally. None of the 18 primary tumors that were treated with SR as definitive therapy have failed to date. All 5 lesions that ultimately failed to be controlled by SR were recurrent tumors that had been treated with SR for salvage of initial surgical failure. Thirteen of the 18 evaluable recurrent tumors (72%) were therefore controlled as of last follow-up. The median tumor volume of the lesions that failed to be controlled by SR was 7.85 cc (range, 3.20 to 10.53 cc) compared to 0.67 cc (range, 0.05 to 12 cc) for controlled lesions (p = 0.0023). The lesions that failed to be controlled by SR received a median minimum tumor dose of 14 Gy (range, 13 to 17 Gy) compared to 16 Gy (range, 12 to 20 Gy) for controlled lesions (p = 0.0239). Seventy-eight percent of the surviving patients remained neurologically stable or clinically improved. There were no significant permanent complications directly attributable to SR. Conclusion: This report documents the largest experience in the literature of the use of SR in the treatment of hemangioblastoma. We conclude that SR: 1) controls the majority of primary and recurrent hemangioblastomas; 2) offers the ability to treat multiple lesions in a single treatment session which is particularly important for patients with VHL; and that 3) better control rates are associated with higher doses and smaller tumor volumes. We believe that SR will play an increasingly important role as a non-invasive alternative therapeutic modality for hemangioblastoma and recommend its use in the following clinical situations: 1) surgically unresectable disease; 2) as adjuvant treatment for subtotally resected disease; 3) as definitive treatment of multifocal disease; and 4) as salvage therapy for radiographically discrete recurrences after surgical failure.}
doi = {10.1016/0360-3016(95)97676-R}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}