CyberKnife stereotactic radiosurgery for the treatment of symptomatic vertebral hemangiomas: a single-institution experience

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Symptomatic vertebral hemangiomas (SVHs) are a very rare pathology that can present with persistent pain or neurological deficits that warrant surgical intervention. Given the relative rarity and difficulty in assessment, the authors sought to present a dedicated series of SVHs treated using stereotactic radiosurgery (SRS) to provide insight into clinical decision making.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective review of a single institution's experience with hypofractionated radiosurgery for SVH from 2004 to 2011 was conducted to determine the clinical and radiographic outcomes following SRS treatment. The authors report and analyze the treatment course of 5 patients with 7 lesions, 2 of which were treated primarily by SRS.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of the 5 patients studied, 4 presented with a chief complaint of pain refractory to conservative measures. Three patients reported dysesthesias, and 2 reported upper-extremity weakness. Following radiosurgery, 4 of 5 patients exhibited improvement in their primary symptoms (3 for pain and 1 for weakness), achieving a clinical response after a mean period of 1 year. In 2 cases there was 20%–40% reduction in lesion size in the most responsive dimension as noted on images. All treatments were well tolerated.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>SRS for SVH is a safe and feasible treatment strategy, comparable to prior radiotherapy studies, and in select cases may successfully confer delayed decompressive effects. Additional investigation will determine future patient selection and how conformal SRS treatment can best be administered.</jats:p></jats:sec>

The Role of Radiotherapy and Surgery in the Management of Aggressive Vertebral Hemangioma: A Retrospective Study of 20 Patients

“…The treatment for aggressive (symptomatic) vertebral body hemangioma, including radiotherapy, ethanol injections, surgical decompression, intralesional vertebrectomy and en-bloc resection, have previously been reported to have good results ( Table 1 ) [ 2 – 4 , 6 – 8 , 13 – 21 , 23 ]. According to the literature, the primary treatment method for aggressive vertebral hemangioma is surgery, while radiotherapy is usually suggested as adjuvant treatment.…”

“…There have previously been few reports describing radiotherapy alone as the treatment of aggressive vertebral hemangioma, especially in cases with neurological deficit, and most of these previous publications were small case series or single case reports ( Table 2 ) [ 15 – 23 ]. Hyde and coauthors [ 6 ] from seven major German institutions reviewed over 39 years of radiotherapy for 84 patients with symptomatic lesions of vertebral hemangioma, including 24 patients presenting with neurological symptoms, and showed an overall patient response rate of 90.5% after a median of 68 months of follow-up.…”

“…However, patients did not completely recover and their muscle strength took more than two years to improve. Zhang et al studied the use of CyberKnife stereotactic radiosurgery for the treatment of vertebral hemangioma at Stanford University, and only four of five patients showed improvement during a mean period of one year [ 23 ].…”

“…The reason for slow or unsatisfactory neurological recovery might be explained by the morphological response of vertebral hemangioma following radiotherapy. In the five cases reported from Stanford University, even with CyberKnife stereotactic radiosurgery, two patients had only between 20–40% reduction in lesion size in the most responsive dimension, as noted on imaging [ 23 ].…”

“…Few previous studies have investigated the effectiveness of radiotherapy in the treatment of aggressive vertebral hemangioma, and the outcome of radiation treatment [ 6 , 15 – 23 ]. There is also controversy regarding whether radiation therapy can induce malignant transformation in benign vertebral hemangioma [ 24 , 25 ].…”