Introduction: Hemangioblastomas are rare, benign CNS tumors often associated with von Hippel-Lindau (VHL) disease. While surgical resection is the standard treatment for symptomatic cases, stereotactic radiosurgery (SRS) is a promising alternative for inoperable or inaccessible lesions. This systematic review evaluates the safety and efficacy of SRS for CNS hemangioblastomas and explores gaps in its clinical management.
Methods: A thorough literature search was performed following PRISMA guidelines, using databases such as PubMed, Scopus, Embase, Web of Science, and the Cochrane Library, with coverage up to October 2024. Studies examining the outcomes of SRS for CNS hemangioblastomas were included, and the risk of bias was assessed using the Joanna Briggs Institute (JBI) tool. Meta-analyses, subgroup analyses, and meta-regression analyses were conducted using R.
Results: A total of 28 studies with 627 patients and 1,761 hemangioblastomas were included. The meta-analysis showed 87% and 80% local tumor control at 5 and 10 years post-SRS, respectively. Tumor response data indicated 28% regression and 59% stability. VHL-associated tumors had better control rates than sporadic tumors (94% vs. 82%). Post-treatment, 16% of patients had worsened symptoms, and the adverse event rate was 11%, with 8% requiring surgical intervention. Meta-regression identified the female sex as a positive predictor for tumor control and fewer complications, while higher radiation doses correlated with increased adverse events. No significant difference was found between SRS modalities (Gamma Knife, CyberKnife, or LINAC).
Conclusion : SRS proves to be an effective and safe option for treating CNS hemangioblastomas, especially in patients with VHL disease or those who are not candidates for surgery. Future prospective studies are needed to further refine patient selection criteria and optimize SRS treatment protocols, considering demographic, genetic, and tumor-specific factors.
.jpg)