Safety and effectiveness of stereotactic radiosurgery for larger hemangioblastomas (>2cc): A multi-center retrospective study

INTRODUCTION: Hemangioblastomas (HGB) are the most common primary intra-axial tumors in the posterior fossa in adults, with an overall occurrence of 7-10%. They occur sporadically or as part of von Hippel-Lindau (VHL) disease. The role of stereotactic radiosurgery (SRS) as a minimally invasive treatment in larger HGB (>2cc) has not been thoroughly investigated. METHODS: This multi-center study retrospectively analyzed data from 91 patients with large HGB (>2cc) treated between 1993 and 2023. Patients were stratified into VHL-associated and sporadic groups, with assessments including radiosurgical parameters, tumor response, overall survival (OS), and progression-free survival (PFS). RESULTS: Patients with VHL-associated HGB were younger at diagnosis (median: 33 years vs. 52 years, p < 0.001) and presented more frequently with multiple tumors (68.8% vs. 23.2%, p < 0.001). Cerebellar lesions were the most common location (70%), followed by brainstem lesions (21%). The median target tumor volume was smaller in VHL cases (3.49 cc vs. 6.5 cc, p = 0.038). Tumor control was achieved in 70% of cases across groups, with no significant differences in outcomes between VHL and sporadic cases. OS (170 months for VHL and 199 months for sporadic cases) and PFS (108 months for both groups) were comparable. Radiation necrosis was observed in 8.8% of patients. CONCLUSIONS: SRS may provide favorable tumor control with low morbidity in both VHL-associated and sporadic cases of larger HGB (>2 cc).Future studies should compare SRS with resection for larger HGB and explore molecular predictors of favorable response to SRS.

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PLoS ONE
Published
2026-04-17
DOI
https://doi.org/10.1371/journal.pone.0337000
Primary Topic
Cancer, Hypoxia, and Metabolism
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article
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0.00

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article

Safety and effectiveness of stereotactic radiosurgery for larger hemangioblastomas (>2cc): A multi-center retrospective study

Herwin Speckter, Roman Liščák, Piero Picozzi, Jonathan E. Schoenhals et al.
PLoS ONE
Cancer, Hypoxia, and Metabolism
article

Safety and effectiveness of stereotactic radiosurgery for larger hemangioblastomas (>2cc): A multi-center retrospective study

Herwin Speckter, Roman Liščák, Piero Picozzi, Jonathan E. Schoenhals, Brad E. Zacharia, Zhishuo Wei, Christopher P. Cifarelli, David Mathieu, Amr M. N. El-Shehaby, Manjul Tripathi, Daniel T. Cifarelli, Jason P. Sheehan, Ahmed M. Nabeel, Huai‐Che Yang, Takuma Sumi, Salem M Tos, Ronald E. Warnick, David Bailey, Georgios Mantziaris, Andrea Franzini, Selçuk Peker, Nuria Martínez Moreno, Takeo Uzuka, Erwin Lazo, Ahmed Taha Elsayed Shaaban, Antonio Dono, Jaromír May, Hideyuki Kano, Roberto Martínez Álvarez, Sameh R. Tawadros, Joshua D. Hack, Reem M. Emad, Lindsay M McKendrick, Angel I. Blanco, Yoshua Esquenazi, Khaled Abdelkarim, Wael A. Reda, L. Dade Lunsford, Ajay Niranjan, Zhiyuan Xu, Pavel S. Pichardo-Rojas, Joshua D. Palmer, Yavuz Samanci, Cheng-chia Lee
article en

Abstract

INTRODUCTION: Hemangioblastomas (HGB) are the most common primary intra-axial tumors in the posterior fossa in adults, with an overall occurrence of 7-10%. They occur sporadically or as part of von Hippel-Lindau (VHL) disease. The role of stereotactic radiosurgery (SRS) as a minimally invasive treatment in larger HGB (>2cc) has not been thoroughly investigated. METHODS: This multi-center study retrospectively analyzed data from 91 patients with large HGB (>2cc) treated between 1993 and 2023. Patients were stratified into VHL-associated and sporadic groups, with assessments including radiosurgical parameters, tumor response, overall survival (OS), and progression-free survival (PFS). RESULTS: Patients with VHL-associated HGB were younger at diagnosis (median: 33 years vs. 52 years, p < 0.001) and presented more frequently with multiple tumors (68.8% vs. 23.2%, p < 0.001). Cerebellar lesions were the most common location (70%), followed by brainstem lesions (21%). The median target tumor volume was smaller in VHL cases (3.49 cc vs. 6.5 cc, p = 0.038). Tumor control was achieved in 70% of cases across groups, with no significant differences in outcomes between VHL and sporadic cases. OS (170 months for VHL and 199 months for sporadic cases) and PFS (108 months for both groups) were comparable. Radiation necrosis was observed in 8.8% of patients. CONCLUSIONS: SRS may provide favorable tumor control with low morbidity in both VHL-associated and sporadic cases of larger HGB (>2 cc).Future studies should compare SRS with resection for larger HGB and explore molecular predictors of favorable response to SRS.

PLoS ONEVol. 21(4)
Ain Shams University (EG), West Virginia University (US), Université de Sherbrooke (CA), Koç University (TR), Cairo University (EG), National Yang Ming Chiao Tung University (TW), Benha University (EG), Centre Hospitalier Universitaire de Sherbrooke (CA), Taipei Veterans General Hospital (TW), Instituto Tecnológico de Santo Domingo (DO), Na Homolce Hospital (CZ), University of Pittsburgh Medical Center (US), Nasser Institute hospital (EG), Hospital Ruber Internacional (ES), Neurological Surgery (US), The University of Texas Health Science Center (US), The Neurological Institute (US), IRCCS Humanitas Research Hospital (IT), Post Graduate Institute of Medical Education and Research (IN), University of Virginia (US), The Ohio State University (US), Jewish Hospital (US), Dokkyo Medical University (JP), Penn State Milton S. Hershey Medical Center (US), The University of Texas Health Science Center at Houston (US)
International Retinal Research Foundation
Good health and well-being
Openalex Percentile: Top 22%
Cancer, Hypoxia, and Metabolism
DOIOpen Access PDFOpenAlex
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