Long-Term Tumor Control with Radiation Therapy for Symptomatic Spine Hemangioma

Abstract

Data are scarce on long-term results of radiotherapy for symptomatic hemangioma of the spine. The purpose of our study is to report imaging and clinical evidence of tumor control with long-term follow-up after radiotherapy for visible tumor that was not well suited to surgical or interventional radiology treatment. Our study population is all 10 patients treated at our institution between 1968 and 2008 for symptomatic hemangioma of the spine. All patients in our series had substantial pain from visible hemangioma at the time of radiotherapy for which surgical resection or interventional radiology procedures where likely to result in high morbidity. Tumor location in the spine included lumbar in 40%, thoracic in 50%, and cervical in 10% of patients. The mean dose delivered was 47 Gy. Clinical follow-up was defined as no symptoms of recurrent tumor after RT. Imaging follow-up was defined as no increase in tumor size after RT. The mean imaging follow-up was 8.1 years and the mean clinical follow-up was 21.2 years. The crude calculation rate of local tumor control was 90% (9/10). The only patient with recurrence demonstrated tumor progression 30 years after RT. The actuarial rate of tumor control was 100% at 5, 10, 20, and 25 years. There were no grade 3+ treatment toxicities, no evidence of malignant transformation, and no evidence of second tumors in the treatment area. RT for symptomatic hemangioma of the spine provides long-term tumor control without complications. Radiation therapy should be considered in patients for whom surgical resection would result in unacceptable morbidity. Our preferred dose program is 45 Gy at 1.8 Gy per treatment.