title: Gamma knife radiosurgery for intracranial hemangioblastomas--outcome at 3 years.
abstract: OBJECTIVE
  To define the role of Gamma Knife radiosurgery (GKRS) for the treatment of patients with hemangioblastomas.
  
  
  METHODS
  Between 1992 and 2009, 26 hemangioblastomas in 14 patients (9 female and 5 male) were treated with GKRS. Mean age of patients at the time of treatment was 45.1 years (range 25-61). von Hippel-Lindau disease was established in 7 patients, and 7 patients had sporadic hemangioblastomas. Twenty-one tumors were solid, 4 were cystic, and 1 had both components. Four patients were treated with upfront radiosurgery, and 10 were treated following a resection. Mean tumor volume was 1.65 cm3 (range 0.08-9.02, median 1.1 cm3). Mean dose to the tumor margin was 18 Gy (range 10-25, median 18). Patients were assessed clinically and radiologically at 6- to 12-month intervals following GKRS. The median follow-up was 3 years (range 0.5-12 years). Kaplan-Meier analysis was used to assess factors predictive of tumor progression, and factors predictive in univariate analysis (P < 0.10) were entered into Cox multivariate regression analysis.
  
  
  RESULTS
  On follow-up, 4 tumors were stable in volume (15%), 14 decreased (54%), and 8 increased (31%). Local tumor control rates at 1, 5, and 10 years was 89%, 74%, and 50%, respectively. There was a trend toward tumor progression in sporadic patients (P = 0.10), women (P = 0.09), and larger tumors (P = 0.10). In patients with multiple hemangioblastomas as compared to those with only a solitary hemangioblastoma, the radiosurgically treated lesion was 7.9 times more likely to progress after GKRS treatment (P = 0.018). This remained the only significant predictor in multivarialble analysis. At the last clinical follow-up, seven patients showed no change or improvement in their symptoms and seven deteriorated.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery offers a reasonable rate of tumor control and preservation of neurologic function in patients with hemangioblastomas. Patients with multiple hemangioblastomas are less likely to exhibit long-term tumor control of treated lesions following radiosurgery.
authors.affiliation: Department of Neurological Surgery,University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Faisal T
authors.initials: FT
authors.lastname: Sayer
authors.forename: James
authors.initials: J
authors.lastname: Nguyen
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Chun-Po
authors.initials: CP
authors.lastname: Yen
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D018325:Hemangioblastoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011859:Radiography; D016634:Radiosurgery / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome; D006623:von Hippel-Lindau Disease / Q000601:surgery