title: Image-guided linear accelerator-based spinal radiosurgery for hemangioblastoma.
abstract: OBJECTIVE
  To retrospectively review the efficacy and safety of image-guided linear accelerator-based radiosurgery for spinal hemangioblastomas.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Selch
authors.forename: Steve
authors.initials: S
authors.lastname: Tenn
authors.forename: Nzhde
authors.initials: N
authors.lastname: Agazaryan
authors.forename: Steve P
authors.initials: SP
authors.lastname: Lee
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gorgulho
authors.forename: Antonio A F
authors.initials: AA
authors.lastname: De Salles