Adjuvant Therapies for Infratentorial Hemangioblastomas in Children

Adjuvant therapy is not required after complete resection of a hemangioblastoma. It can be considered to manage lesions not amenable to surgical treatment.

Radiation

• Conventional therapy: Conventional radiotherapy may be considered for the management of surgically inaccessible and/or multiple hemangioblastomas in older children or adolescents. The goal is to avoid multiple operations in cases of hemangioblastomatosis or to delay surgery on a tumor with progressive growth.

• Stereotactic radiosurgery: Stereotactic radiosurgery may be considered for appropriate targets at doses of 20–24 Gy through a frame-based linear accelerator, Gamma-knife, or Cyberknife (2, 4, 35). Radiosurgery is indicated for hemangioblastomas with a mean volume of 1–2 cm3 (range: 0.01–65 cm3).

Chemotherapy

• Antiangiogenic therapy: VEGF inhibition can be used to delay the growth of progressing and inoperable hemangioblastomas (32). Otherwise, the low proliferative index of these tumors renders them resistant to chemotherapy.