Radiotherapy efficacies for vertebral hemangioma patients with severe spinal cord compression and cauda equina syndrome

Background: Although vertebral hemangioma is the most common benign spine tumor, rare patients may experience spinal cord compression accompanied by pain and neurological deficits, in whom surgery remains the standard treatment option. For patients with comorbidities who cannot tolerate operation, radiotherapy may be an alternative treatment, however, previous studies suggested that if spinal cord cannel was aggressively compressed by vertebral hemangioma, the efficacies of radiotherapy were suboptimal. Methods and results: Herein, we presented two patients with vertebral hemangioma who developed spinal cord compression, first patient with underlying congenital heart disease had spinal canal encroachment of 63.4% at ninth thoracic vertebra, and second patient failed to transcatheter arterial embolization for treating total encroachment of sacrum plexus. The first patient underwent radiotherapy with 44 Gy at 20 fractions using Tomotherapy and became fully recovered from the severe neurological deficits at 5.5 months after completing radiotherapy. The second patient benefited from neurological symptoms relief at 6 months after completion of radiotherapy using 42 Gy at 21 fractions using volumetric modulated arc therapy (VMAT) technique.Conclusions: Our results indicate that radiotherapy with 42 to 44 Gy using conventional fractions could efficiently cause tumor regressions and improve neurological symptoms resulted from vertebral hemangioma-causing spinal cord compression.