title: The long-term outcomes of radiosurgery for intracranial hemangioblastomas.
abstract: BACKGROUND
  Optimal timing in the treatment of intracranial hemangioblastoma (HB) remains controversial, particularly for patients of von Hippel-Lindau disease (VHL) with multiple small lesions. We evaluated efficacy of stereotactic radiosurgery (SRS) for intracranial HB based on the longer follow-up data with a larger number of patients and lesions.
  
  
  METHODS
  Twenty-one patients (11 men, 10 women) initially underwent SRS for 57 intracranial HBs. Seven patients had sporadic lesions and 14 had VHL-related lesions. During the follow-up, 40 lesions were additionally treated in VHL patients in 10 SRS treatments. Thus, a total of 97 lesions were included in this study. Median tumor volume was 0.13 cm(3) (range, 0.004-9.5 cm(3)), and median margin dose was 18 Gy (range, 14-20 Gy).
  
  
  RESULTS
  Median duration of follow-up was 96 months (range, 3-235 mo) after initial SRS treatment. Ten tumors in 7 patients showed progression after SRS. Actuarial tumor control rates after SRS at 5 and 10 years were 94% and 80%, respectively. Factors associated with longer control were solid lesion (P = .03), smaller volume (P = .01), and lesions associated with VHL (P = .0005) in univariate analysis. Five- and 10-year tumor control rates were 67% and 44% for sporadic patients and 97% and 83% for VHL patients.
  
  
  CONCLUSIONS
  SRS could be offered as an effective treatment for small, solid, and VHL-associated HBs. If the tumors show apparent enlargement in size or can possibly become symptomatic along with a slight increase in size, SRS should be recommended before they present with the clinical symptoms.
authors: Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan (S.H., T.K., M.S., S.T., A.M., N.S.); Department of Radiology, University of Tokyo Hospital, Tokyo, Japan (M.T., H.I.).
authors: Shunya
authors: S
authors: Hanakita
authors: Tomoyuki
authors: T
authors: Koga
authors: Masahiro
authors: M
authors: Shin
authors: Shunsaku
authors: S
authors: Takayanagi
authors: Akitake
authors: A
authors: Mukasa
authors: Masao
authors: M
authors: Tago
authors: Hiroshi
authors: H
authors: Igaki
authors: Nobuhito
authors: N
authors: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002528:Cerebellar Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018325:Hemangioblastoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: gamma knife surgery; intracranial hemangioblastomas; stereotactic radiosurgery; von Hippel-Lindau disease