Is there a dose-effect relationship for the treatment of symptomatic vertebral hemangioma?

Purpose: Symptomatic vertebral hemangiomas are rare vascular lesions. Radiotherapy is the most common treatment. Because of a lack of information in the literature, uncertainty exists about the total radiation dose to be applied. Methods and Materials: Individual data from our own and published patients with symptomatic vertebral hemangioma treated with radiotherapy alone were obtained. The data were pooled, and the impact of the total dose on complete pain relief was evaluated using the chi-square test. Because different single-fraction doses were used, the equivalent dose in 2-Gy fractions (EQD₂) was used for the analysis. Results: Complete data could be obtained from 117 patients. Patients were categorized according to total dose (EQD₂) into two groups of similar size (Group A: 20-34 Gy, n = 62; and Group B: 36-44 Gy, n = 55). Radiation-induced complete pain relief was achieved in 39% (24/62) of the patients in Group A and in 82% (45/55) of the patients in Group B. The difference was statistically significant (p = 0.003). Conclusions: The data suggest a dose-effect relationship in the radiotherapy of symptomatic vertebral hemangiomas. We recommend a total radiation dose 36-40 Gy with a dose per fraction of 2.0 Gy.