Radiotherapy for large symptomatic hemangiomas

Schild, Steven E.; Buskirk, Steven J.; Frick, Lorraine M.; Cupps, Roger E.

doi:10.1016/0360-3016(91)90693-x

Cited by 75 publications

(51 citation statements)

References 12 publications

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“…These rates and timelines are consistent with those in the existing radiotherapy literature. 14,19,23 Miszczyk and Tukiendorf reported complete pain relief in 64% of patients at 1.5 years compared with 36% at 1 month. 18 This adds evidence to a hypothesis suggesting that SVH relief following SRS is more often a delayed outcome, unlike that seen in the prior SRS case report.…”

Section: Discussionmentioning

confidence: 99%

“…Favorable outcomes exhibited on follow-up images obtained after radiotherapy and SRS for the treatment of such vascular malformations have been correlated with clinical improvement, particularly in the intracranial lesion literature. 9,[14][15][16]21,23,25 However, the significance and likelihood of radiographic changes in the spine are still disputed. 14,22 Predicting which lesions are most amenable to radiosurgical shrinkage should continue to be of ongoing interest for such vascular spinal lesions, as their extramedullary proximity to the spinal cord will be a major determinant of optimal SRS dosing when radiotherapy cannot achieve sufficient conformity.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Chen

Chang

et al. 2017

FOC

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OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Zhang

Chen

Chang

et al. 2017

FOC

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“…With the development of intensity-modulated radiation therapy, it may be possible to safely deliver higher doses of radiation while avoiding complications such as radiation myelopathy and pulmonary radionecrosis, but this has not been shown in patients with vertebral hemangiomas. 3,16,62 It should be noted that the radiographic appearance of aggressive vertebral hemangiomas has not been reported to change after a number of years, even with successful treatment. 24,52 This likely indicates that radiation is effective at controlling pathological vascular tissue but does not have a radiographically demonstrable effect on the surrounding bony tissue.…”

Section: Radiation Therapymentioning

confidence: 99%

Surgical treatment of aggressive vertebral hemangiomas

Vasudeva

John

Groff

2016

FOC

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OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of “hemangioma” between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3–65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.

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“…Bu amaçla en sık 40 Gy doz öne-rilmektedir. [8,20] Templin ve ark.nın [16] çalışmasında 20-34 Gy arası doz alan hastaların %39'unda, 36-40 Gy radyoterapi uygulanan hastaların ise %82'sinde ağrı palyasyonu sağlan-mıştır.…”

Section: Discussionunclassified