CyberKnife Stereotactic Radiosurgery for Spinal Haemangioblastoma: A Single Centre Experience

Abstract

Abstract AIMS ‘CyberKnife’ stereotactic radiosurgery (SRS) is increasingly being used as a treatment for spinal haemangioblastoma to avoid complex surgery, especially in patients with multi-focal tumours associated with von Hippel-Lindau syndrome (VHL). Here we present the outcomes of patients treated in our centre. METHOD Retrospective review of patients treated at St Bartholomew’s Hospital, London. Assessment of radiological response was based upon RECIST criteria. The development of a symptomatic new or worsening cyst was included in the definition of progression when determining overall tumour control. Solid and overall tumour control rates were calculated using the Kaplan-Meier method. RESULTS 14 tumours in 10 patients were included. 70% of patients were male and 90% had VHL. 9 (64%) tumours had an associated cyst. The median (IQR) age at treatment was 45.5 (43.5 – 53). The median gross tumour volume was 0.355cc. Patients received a mean marginal prescribed dose of 9.6Gy in a single fraction (mean central dose 14Gy) – dose constrained by spinal cord tolerance. Mean follow up was 15.4 months. 7 patients’ symptoms improved or were stable and 3 worsened. Radiologically, 11 (78.6%) of tumours were stable or regressed, and 3 (21.4%) progressed. The 1-year solid tumour and overall tumour control rates were 92.3% and 75.7% respectively. All patients were alive at most recent follow up. 2 patients developed grade 1 adverse related events. CONCLUSION SRS is a safe and effective treatment modality for spinal haemangioblastoma. Further prospective randomised trials with longer follow up are required to determine the optimum management strategy.