Introduction: Haemangioblastoma is a benign, vascular tumour of the central nervous system. Stereotactic radiosurgery (SRS) is increasingly being used as a treatment for spinal lesions 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 using a CyberKnife VSI (Accuray, Inc.). Methods: Retrospective analysis of all patients treated at our institution was conducted. Assessment of radiological response was based upon RANO criteria. Solid and overall tumour progression-free survival (PFS) was calculated using the Kaplan-Meier method. The development of a symptomatic new or enlarging cyst was included in the definition of progression when determining overall PFS. Results: Fourteen tumours in 10 patients were included. Seven patients were male, and nine had VHL. Nine (64%) tumours had an associated cyst. The median (IQR) age at treatment was 45.5 (43.5–53) years. The median gross tumour volume was 0.355cc. Patients received a mean marginal prescribed dose of 9.6 Gy in a single fraction (median maximum dose: 14.3 Gy), which was constrained by spinal cord tolerance. Mean follow-up was 15.4 months. Radiologically, 11 (78.6%) tumours were stable or regressed and three (21.4%) progressed. Eight patients’ symptoms improved or were stable, and two worsened, both of which were secondary to cyst enlargement. The 1-year solid-tumour and overall PFS was 92.3% and 75.7%, respectively. All patients were alive at the most recent follow-up. One patient developed grade 1 back pain following treatment. Discussion/Conclusion: SRS appears to be a safe and effective treatment for spinal haemangioblastoma. Prospective trials with longer follow-up are required to establish the optimum management.

Pan J, Jabarkheel R, Huang Y, Ho A, Chang SD. Stereotactic radiosurgery for central nervous system hemangioblastoma: systematic review and meta-analysis. J Neurooncol. 2018 Mar;137(1):11–22.
Lonser RR, Oldfield EH. Spinal cord hemangioblastomas. Neurosurg Clin N Am. 2006 Jan;17(1):37–44.
Conway JE, Chou D, Clatterbuck RE, Brem H, Long DM, Rigamonti D. Hemangioblastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease. Neurosurgery. 2001 Jan;48(1):55–63; discussion 62-3
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007 Aug;114(2):97–109.
Selch MT, Tenn S, Agazaryan N, Lee SP, Gorgulho A, De Salles AAF. Image-guided linear accelerator-based spinal radiosurgery for hemangioblastoma. Surg Neurol Int. 2012;3:73.
Serban D, Exergian F. Intramedullary hemangioblastoma: local experience of a tertiary clinic. Chirurgia. 2013;108(3):325–30.
Bridges KJ, Jaboin JJ, Kubicky CD, Than KD. Stereotactic radiosurgery versus surgical resection for spinal hemangioblastoma: a systematic review. Clin Neurol Neurosurg. 2017 Mar;154:59–66.
Zec N, Cera P, Towfighi J. Extramedullary hematopoiesis in cerebellar hemangioblastoma. Neurosurgery. 1991 Jul;29(1):34–7.
Pan J, Ho AL, D'Astous M, Sussman ES, Thompson PA, Tayag AT, et al. Image-guided stereotactic radiosurgery for treatment of spinal hemangioblastoma. Neurosurg Focus. 2017 Jan;42(1):E12.
Moss JM, Choi CYH, Adler JR Jr, Soltys SG, Gibbs IC, Chang SD. Stereotactic radiosurgical treatment of cranial and spinal hemangioblastomas. Neurosurgery. 2009 Jul;65(1):79–85.
Chakraborti PR, Chakrabarti KB, Doughty D, Plowman PN. Stereotactic multiple are radiotherapy. IV--Haemangioblastoma. Br J Neurosurg. 1997 Apr;11(2):110–5.
Wen PY, Chang SM, Van den Bent MJ, Vogelbaum MA, Macdonald DR, Lee EQ. Response assessment in neuro-oncology clinical trials. J Clin Oncol. 2017;35(21):2439–49.
Chang SD, Meisel JA, Hancock SL, Martin DP, McManus M, Adler JR Jr. Treatment of hemangioblastomas in von Hippel-Lindau disease with linear accelerator-based radiosurgery. Neurosurgery. 1998 Jul;43(1):28–34.
Ryu SI, Kim DH, Chang SD. Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord. Neurosurg Focus. 2003 Nov 15;15(5):E10.
Bhatnagar AK, Gerszten PC, Ozhasaglu C, Vogel WJ, Kalnicki S, Welch WC, et al. CyberKnife Frameless Radiosurgery for the treatment of extracranial benign tumors. Technol Cancer Res Treat. 2005 Oct;4(5):571–6.
Chang UK, Rhee CH, Youn SM, Lee DH, Park SQ. Radiosurgery using the Cyberknife for benign spinal tumors: korea cancer center hospital experience. J Neurooncol. 2011 Jan;101(1):91–9.
Daly ME, Choi CYH, Gibbs IC, Adler JR Jr., Chang SD, Lieberson RE, et al. Tolerance of the spinal cord to stereotactic radiosurgery: insights from hemangioblastomas. Int J Radiat Oncol Biol Phys. 2011 May 1;80(1):213–20.
Blaty D, Malos M, Palmrose T, McGirr S. Sporadic intradural extramedullary hemangioblastoma of the cauda equina: case report and literature review. World Neurosurg. 2018 Jan;109:436–41.
Kalash R, Glaser SM, Flickinger JC, Burton S, Heron DE, Gerszten PC, et al. Stereotactic body radiation therapy for benign spine tumors: is dose de-escalation appropriate? J Neurosurg Spine. 2018 Aug;29(2):220–5.
Cvek J, Knybel L, Reguli S, Lipina R, Hanzlikova P, Šilhán P, et al. Stereotactic radiotherapy for spinal hemangioblastoma: disease control and volume analysis in long-term follow up. Rep Pract Oncol Radiother. 2022;27(1):134–41.
Pan L, Wang EM, Wang BJ, Zhou LF, Zhang N, Cai PW, et al. Gamma knife radiosurgery for hemangioblastomas. Stereotact Funct Neurosurg. 1998 Oct;70(Suppl 1):179–86.
Matsunaga S, Shuto T, Inomori S, Fujino H, Yamamoto I. Gamma knife radiosurgery for intracranial haemangioblastomas. Acta Neurochir. 2007 Oct;149(10):1007–13.
Kano H, Niranjan A, Mongia S, Kondziolka D, Flickinger JC, Lunsford LD. The role of stereotactic radiosurgery for intracranial hemangioblastomas. Neurosurgery. 2008 Sep;63(3):443–50.
Puataweepong P, Dhanachai M, Hansasuta A, Dangprasert S, Sitathanee C, Puddhikarant P, et al. The clinical outcome of intracranial hemangioblastomas treated with linac-based stereotactic radiosurgery and radiotherapy. J Radiat Res. 2014 Jul;55(4):761–8.
Kano H, Shuto T, Iwai Y, Sheehan J, Yamamoto M, McBride HL, et al. Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective international outcome study. J Neurosurg. 2015 Jun;122(6):1469–78.
Wanebo JE, Lonser RR, Glenn GM, Oldfield EH. The natural history of hemangioblastomas of the central nervous system in patients with von Hippel-Lindau disease. J Neurosurg. 2003 Jan;98(1):82–94.
Grimm J, Sahgal A, Soltys SG, Luxton G, Patel A, Herbert S, et al. Estimated risk level of unified stereotactic body radiation therapy dose tolerance limits for spinal cord. Semin Radiat Oncol. 2016 Apr;26(2):165–71.
Hanna GG, McDonald F, Murray L, Harrow S, Landau D, Ahmed M, et al. UK Consensus on normal tissue dose constraints for stereotactic radiotherapy: reply to Ghafoor et al. Clin Oncol. 2018 Jan;30(7):456–14.
Sahgal A, Chang JH, Ma L, Marks LB, Milano MT, Medin P, et al. Spinal cord dose tolerance to stereotactic body radiation therapy. Int J Rad Oncol Biol Phy. 2021 May 1;110(1):124–36.
Ammerman JM, Lonser RR, Dambrosia J, Butman JA, Oldfield EH. Long-term natural history of hemangioblastomas in patients with von Hippel-Lindau disease: implications for treatment. J Neurosurg. 2006 Aug;105(2):248–55.
Feldman MJ, Sizdahkhani S, Edwards NA, Merrill MJ, Ray-Chaudhury A, Zhuang Z, et al. Loss of quiescence in von Hippel-lindau hemangioblastomas is associated with erythropoietin signaling. Sci Rep. 2016 Oct 17;6(1):35486.
Hanakita S, Koga T, Shin M, Takayanagi S, Mukasa A, Tago M, et al. The long-term outcomes of radiosurgery for intracranial hemangioblastomas. Neuro Oncol. 2014 Mar;16(3):429–33.
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