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Golub D, McBriar JD, Donaldson H, Wong T, Unadkat P, White TG, Quach ET, Haddock S, Chitti B, Ziemba Y, Goenka A, Singer S, Schulder M, Dehdashti AR. Postoperative stereotactic radiosurgery for intracranial solitary fibrous tumors: systematic review and pooled quantitative analysis. J Neurooncol 2023; 165:229-239. [PMID: 37955760 DOI: 10.1007/s11060-023-04499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Intracranial solitary fibrous tumors (SFTs), formerly hemangiopericytomas (HPCs), are rare, aggressive dural-based mesenchymal tumors. While adjuvant radiation therapy has been suggested to improve local tumor control (LTC), especially after subtotal resection, the role of postoperative stereotactic radiosurgery (SRS) and the optimal SRS dosing strategy remain poorly defined. METHODS PubMed, EMBASE, and Web of Science were systematically searched according to PRISMA guidelines for studies describing postoperative SRS for intracranial SFTs. The search strategy was defined in the authors' PROSPERO protocol (CRD42023454258). RESULTS 15 studies were included describing 293 patients harboring 476 intracranial residual or recurrent SFTs treated with postoperative SRS. At a mean follow-up of 21-77 months, LTC rate after SRS was 46.4-93% with a mean margin SRS dose of 13.5-21.7 Gy, mean maximum dose of 27-39.6 Gy, and mean isodose at the 42.5-77% line. In pooled analysis of individual tumor outcomes, 18.7% of SFTs demonstrated a complete SRS response, 31.7% had a partial response, 18.9% remained stable (overall LTC rate of 69.3%), and 30.7% progressed. When studies were stratified by margin dose, a mean margin dose > 15 Gy showed an improvement in LTC rate (74.7% versus 65.7%). CONCLUSIONS SRS is a safe and effective treatment for intracranial SFTs. In the setting of measurable disease, our pooled data suggests a potential dose response of improving LTC with increasing SRS margin dose. Our improved understanding of the aggressive biology of SFTs and the tolerated adjuvant SRS parameters supports potentially earlier use of SRS in the postoperative treatment paradigm for intracranial SFTs.
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Affiliation(s)
- Danielle Golub
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA.
| | - Joshua D McBriar
- Zucker School of Medicine, Hofstra University/Northwell Health, Hempstead, NY, USA
| | - Hayley Donaldson
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Taylor Wong
- SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Prashin Unadkat
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Timothy G White
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Eric T Quach
- Department of Neurosurgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Sara Haddock
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Bhargava Chitti
- Department of Radiation Oncology, Northwell Health, Manhasset, NY, USA
| | - Yonah Ziemba
- Department of Pathology, Northwell Health, Manhasset, NY, USA
| | - Anuj Goenka
- Department of Radiation Oncology, Northwell Health, Manhasset, NY, USA
| | - Samuel Singer
- Department of Neurology, Northwell Health, New Hyde Park, NY, USA
| | - Michael Schulder
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
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2
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Wu Y, Gong L, Zhang Y, Zheng M, Li J, Xue Y, Qu Y, Zhao T. Endoscopic endonasal resection of two rare cases of hemangiopericytomas invading the cavernous sinus and literature review. Front Surg 2022; 9:1035635. [PMID: 36386546 PMCID: PMC9649903 DOI: 10.3389/fsurg.2022.1035635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
Hemangiopericytomas (HPCs) invading the cavernous sinus (CS) are extremely rare invasive tumors that have a great propensity for local recurrence. To date, only eight cases have been reported in the literature. Owing to the abundant vascular supply of HPCs, intracavernous bleeding and important blood vessels and nerves passing through the CS, it is very difficult and challenging for neurosurgeons to completely resect HPCs. Here, we report two cases of HPCs invading the CS and introduce their clinical manifestations, imaging findings, surgical approaches and histopathological features in detail. We have implemented the surgery by the endoscopic transpterygoid transcavernous approach (ETPTCa) for the two patients, and one patient has undergone gross total resection (GTR) and another has undergone subtotal resection (STR) and postoperative stereotactic radiosurgery (SRS). The ETPTCa may serve as a viable option to facilitate HPCs resection. Radiotherapy is helpful in prolonging progression-free survival (PFS) following STR of the tumor.
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Affiliation(s)
- Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Li Gong
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yunze Zhang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Min Zheng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Junting Li
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, China,Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, China,Correspondence: Tianzhi Zhao Yan Qu
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, China,Correspondence: Tianzhi Zhao Yan Qu
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3
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Sixteen-Year Follow-Up in a Cavernous Sinus Hemangiopericytoma: Improved Outcomes over Radiotherapy Advances. Brain Sci 2022; 12:brainsci12091209. [PMID: 36138945 PMCID: PMC9497113 DOI: 10.3390/brainsci12091209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Intracranial hemangiopericytomas are rare tumors, accounting for 1% of all central nervous system malignancies. This tumor is considered at high risk of local and also distant metastases. Surgical excision is the gold standard for treatment, but it is seldom curative by itself. Adjuvant radiotherapy is often recommended. We report an overview and update of the available literature on one such rare but aggressive mesenchymal tumor, using the case of a 46-year-old woman affected by hemangiopericytoma of the cavernous sinus surgically removed and treated with adjuvant radiotherapy at our institution. After seven years, the patient underwent a local recurrence and was treated with exeresis and Gamma Knife radiotherapy. Sixteen years after the initial diagnosis, she is still well with stable disease.
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4
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Allen AJ, Labella DA, Richardson KM, Sheehan JP, Kersh CR. Recurrent Solitary Fibrous Tumor (Intracranial Hemangiopericytoma) Treated With a Novel Combined-Modality Radiosurgery Technique: A Case Report and Review of the Literature. Front Oncol 2022; 12:907324. [PMID: 35720016 PMCID: PMC9204631 DOI: 10.3389/fonc.2022.907324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Solitary Fibrous Tumor (SFT) is a rare and aggressive mesenchymal malignancy of the dura with a predilection for recurrence after treatment. We report a case of a SFT initially treated with subtotal surgical resection followed by a combination of Gamma Knife (GK) and linear accelerator-based radiosurgery. Forty-four days post-resection, the tumor had demonstrated radiographic evidence of recurrent disease within the post-operative bed. GK radiosurgery treatment was delivered in a "four-matrix" fashion targeting the entire surgical cavity as well as three nodular areas within this wide field. This treatment was delivered in one fraction with a stereotactic head frame for immobilization. A consolidation radiosurgery treatment course was then delivered over three additional fractions to the resection bed using a linear accelerator and mesh mask for immobilization. The total biologically effective dose (BED) was calculated as 32.50 Gy to the surgical bed and approximately 76.50 Gy to each nodular area. Almost three years post-operatively, the patient is alive and without radiographic or clinical evidence of disease recurrence. To our knowledge, no prior experiences have documented treatment of SFT using a mixed-modality, multi-fraction radiosurgery technique like the method detailed in this report. Our experience describes a combined modality, multi-fraction radiosurgery approach to treating recurrent SFT that maximizes radiation dose to the targets while minimizing complication risk. We believe this novel radiosurgery method should be considered in cases of grade II SFT post-resection.
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Affiliation(s)
- Alexander J Allen
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
| | - Dominic Angelo Labella
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
| | - K Martin Richardson
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Charles R Kersh
- Chesapeake Regional, Riverside & University of Virginia Radiosurgery Center, Riverside Regional Medical Center, Newport News, VA, United States
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5
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Less common extracerebral tumors. PROGRESS IN BRAIN RESEARCH 2022; 268:279-302. [PMID: 35074086 DOI: 10.1016/bs.pbr.2021.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This chapter examines the results of GKNS on a variety of extraparenchymal skull base tumors some benign and some malignant. For the benign tumors there is good evidence on the effectiveness of the method for pretty much all diagnoses. For malignant extraparenchymal tumors the results are more limited and GKNS only has a supportive role in these lesions.
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Huang L, Bai J, Zhang Y, Cui Z, Zhang Z, Li J, Wang J, Yu X, Ling Z, Qu B, Pan L. Treatment of Residual, Recurrent, or Metastatic Intracranial Hemangiopericytomas With Stereotactic Radiotherapy Using CyberKnife. Front Oncol 2021; 11:577054. [PMID: 33763346 PMCID: PMC7982841 DOI: 10.3389/fonc.2021.577054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Hemangiopericytomas are aggressive tumors known for their recurrence. The purpose of this study was to evaluate the management of residual, recurrent, and metastatic intracranial hemangiopericytomas using CyberKnife (CK) stereotactic radiotherapy (SRT). Materials and Methods Data were collected from 15 patients (28 tumors; eight men and seven women; 32–58 years) with residual, recurrent, or metastatic intracranial hemangiopericytomas, who were treated with stereotactic radiotherapy using CyberKnife between January 2014 and August 2019. All patients had previously been treated with surgical resection. Initial tumor volumes ranged from 0.84 to 67.2 cm3, with a mean volume of 13.06 cm3. The mean marginal and maximum radiosurgical doses to the tumors were 21.1 and 28.76 Gy, respectively. The mean follow-up time for tumors was 34.5 months, ranging from 13 to 77 months. Results 15 patients were alive after treatment; the mean post-diagnosis survival at censoring was 45.6 months (range 13–77 months). The volumes of the 28 tumors in the 15 followed patients were calculated after treatment. Postoperative magnetic resonance imaging revealed a mean tumor volume of 6.72 cm3 and a range of 0–67.2 cm3, with the volumes being significantly lower than pretreatment values. Follow-up imaging studies demonstrated tumor disappearance in seven (25%) of 28 tumors, reduction in 14 (50%), stability in one (3.57%), and recurrence in six (21.4%). Total tumor control was achieved in 22 (78.5%) of 28 tumors. The tumor grade and fraction time were not significantly associated with progression-free survival. Intracranial metastasis occurred in three patients, and extraneural metastasis in one patient. Conclusions On the basis of the current results, stereotactic radiotherapy using CyberKnife is an effective and safe option for residual, recurrent, and metastatic intracranial hemangiopericytomas. Long-term close clinical and imaging follow-up is also necessary.
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Affiliation(s)
- Lichao Huang
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China.,Department of Neurosurgery, The Hospital of 81st Group Army PLA, Zhangjiakou, China
| | - Jingmin Bai
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yanyang Zhang
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhiqiang Cui
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhizhong Zhang
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jiwei Li
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jinyuan Wang
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhipei Ling
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China
| | - Baolin Qu
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Longsheng Pan
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing, China
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7
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Lottin M, Escande A, Peyre M, Sevestre H, Maurage CA, Chauffert B, Penel N. [What's new in the management of meningeal solitary fibrous tumor/hemangiopericytoma?]. Bull Cancer 2020; 107:1260-1273. [PMID: 33160607 DOI: 10.1016/j.bulcan.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/26/2020] [Indexed: 12/18/2022]
Abstract
Meningeal fibrous solitary tumors/hemangiopericytoma are rare and aggressive mesenchymal neoplasms considered as sarcomas. They represent less than 1% of intracranial tumors and derive from the pericytes of Zimmerman which permit capillary contraction. They tend to occur more often in males in the fifth decade. They are often revealed by intracranial hypertension. Some scannographic and MRI characteristics permit to distinguish meningeal fibrous solitary tumor/hemangiopericytoma from other meningeal tumors. Meningeal hemangiopericytoma and fibrous solitary tumors were considered as different entities until 2016. Following the discovery of an identical genetic event, the locus 12q13 chromosome inversion leading to a NAB2-STAT6 fusion with nuclear immunoreactivity for STAT6 protein, the 2016 WHO classification defines these tumors as a single entity. Meningeal fibrous solitary tumors/hemangiopericytoma have a high recurrence rate. Long-term recurrences may occur. Local relapses are more frequent than extracranial metastasis. A multimodal management is recommended to treat a localized disease. It involves a complete resection followed by adjuvant radiotherapy. When local recurrences occur, surgery or stereotactic radiosurgery permit sometimes a local control. Metastatic disease has a poor prognostic and a weak chimiosensitivity. Targeted therapies, like pazopanib, are a hopeful option.
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Affiliation(s)
- Marine Lottin
- CHU d'Amiens, service d'oncologie médicale, Amiens, France.
| | - Alexandre Escande
- Centre Oscar-Lambret, service universitaire de radiothérapie, Lille, France; Université de Lille, faculté de médecine, H. Warembourg, Lille, France; Université de Lille, Villeneuve d'Ascq, laboratoire CRIStAL, UMR 9189, Amiens, France
| | - Matthieu Peyre
- Sorbonnes universités, CHU de La Pitié Salpetrière, service de neurochirurgie, Paris, France
| | | | | | | | - Nicolas Penel
- Université de Lille, centre Oscar-Lambret, département d'oncologie médicale, Lille, France
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Abstract
The management of patients harboring central nervous system (CNS) hemangiopericytomas (HPCs) is a partially answered challenge. These are rare locally aggressive lesions, with potential for local recurrence, distal neural metastasis (DNM), and extraneural metastasis (ENM). Resection, when feasible, remains the initial treatment option, providing histological diagnosis and immediate relief of tumor-related mass effect. Patients receiving surgery alone or surgery and external beam radiotherapy (EBRT) show improved overall survival (OS) and progression-free survival as compared to those undergoing a biopsy alone (p = 0.01 and p = 0.02, respectively). Yet, in many instances, patient and tumor-related parameters preclude complete resection. EBRT or stereotactic radiosurgery (SRS) shares a significant role in achieving local tumor control, not shown to impact OS in HPC patients. The benefits of SRS/EBRT are clearly limited to improved local tumor volume control and neurologic function, not affecting DNM or ENM development. SRS provides acceptable rates of local tumor volume control coupled with treatment safety and a patient-friendly apparatus and procedure. Single-session SRS is most effective for lesions measuring <2 cm in their largest diameter (10 cm3 volume), with prescription doses of at >15 Gy. Systemic HPC disease is managed with various chemotherapeutic, immunotherapeutic, and anti-angiographic agents, with limited success. We present a short discussion on CNS HPCs, focusing our discussion on available evidence regarding the role of microsurgical resection, EBRT, SRS, chemotherapy, and immunotherapy for upfront, part of adoptive hybrid surgery approach or for recurrent HPCs.
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9
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Nakajo K, Iwai Y, Yoshimura M, Watanabe Y, Yamanaka K. Intracavernous Hemangiopericytoma: Case Report and Review of the Literature. NMC Case Rep J 2019; 6:111-115. [PMID: 31592158 PMCID: PMC6776749 DOI: 10.2176/nmccrj.cr.2018-0300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/25/2019] [Indexed: 11/29/2022] Open
Abstract
Intracavernous hemangiopericytoma/solitary fibrous tumor is an extremely rare tumor, with only seven cases reported. We present a case of intracavernous hemangiopericytoma/solitary fibrous tumor and review all cases reported in the literature. A 67-year-old man experienced numbness over the left half of the face. Magnetic resonance imaging revealed a left intracavernous tumor extending into Meckel’s cave and the posterior fossa. We performed gamma knife surgery (GKS) which a prescribed dose to the tumor of 12 Gy, but tumor recurred 43 months after GKS. We performed partial tumor resection via a subtemporal interdural approach. The pathological diagnosis was hemangiopericytoma. Postoperatively, we performed second GKS with a prescribed dose of 15 Gy. Diplopia and ptosis improved markedly and the tumor initially reduced in size, but tumor regrowth was seen again 29 months after second GKS. Third GKS was performed with a prescribed dose of 15 Gy. Recurrence was not seen at 18 months after third GKS, but was identified about 2 years after third GKS. We performed fourth GKS with a prescribed dose to the residual tumor of 16 Gy. We report a rare case of intracavernous hemangiopericytoma originating in the cavernous sinus, but distinguishing between hemangiopericytoma and schwannoma is difficult for round, intracavernous tumors showing homogeneous enhancement without flow voids. GKS might be one of the options for residual and recurrent intracavernous hemangiopericytomas.
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Affiliation(s)
- Kosuke Nakajo
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Yoshiyasu Iwai
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Masaki Yoshimura
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Yusuke Watanabe
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Kazuhiro Yamanaka
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Osaka, Japan
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Sung KS, Moon JH, Kim EH, Kang SG, Kim SH, Suh CO, Kim SH, Lee KS, Chang WS, Chang JH. Solitary fibrous tumor/hemangiopericytoma: treatment results based on the 2016 WHO classification. J Neurosurg 2019; 130:418-425. [PMID: 29521591 DOI: 10.3171/2017.9.jns171057] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/25/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a new combined entity for which a soft-tissue-type grading system, ranging from grades I to III, has been introduced in the 2016 WHO classification of tumors of the CNS. The results of the treatment of this new disease entity require evaluation. METHODS The authors retrospectively reevaluated the pathological findings and medical records of patients with SFT/HPC. This study included 60 patients (27 men and 33 women, median age 42.5 years, range 13-69 years) treated at Severance Hospital between February 1981 and February 2016. Four, 40, and 16 patients were categorized as having SFT/HPC grades I, II, and III, respectively. Among these patients, SFTs diagnosed in 7 patients were regraded as grades I (n = 4), II (n = 2), and III (n = 1). RESULTS The median overall survival (OS) was 73.2 months (range 1.4-275.7 months), and the progression-free survival (PFS) after the first operation was 53.8 months (range 1.4-217.7 months). Six patients (10%) showed extracranial metastasis during a median period of 103.7 months (range 31.9-182.3 months). Nineteen patients (31.7%) presented with tumor recurrences. The patients in the grade III group had shorter PFS and OS, as well as a shorter period to extracranial metastasis, compared with patients in the grade II group. In the grade II group, patients who underwent gross-total resection showed longer PFS than those who underwent subtotal resection; however, there was no difference in OS. Patients who underwent adjuvant radiation therapy (RT) after surgery had longer PFS compared with that of patients who did not undergo adjuvant RT. CONCLUSIONS The SFT/HPC grade I group showed a relatively benign course compared with those of the other groups. The grade III group presented a course with a more aggressive nature than that of the grade II group. In the grade II group, the extent of resection and adjuvant RT was significantly associated with longer PFS. The long-term follow-up and periodic systemic evaluation are mandatory to detect systemic metastasis.
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Affiliation(s)
- Kyoung Su Sung
- 1Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan; Departments of
| | | | - Eui Hyun Kim
- 2Neurosurgery
- 3Brain Tumor Center and
- 6Brain Research Institute, Yonsei University Health System, Yonsei University College of Medicine; and
| | - Seok-Gu Kang
- 2Neurosurgery
- 3Brain Tumor Center and
- 6Brain Research Institute, Yonsei University Health System, Yonsei University College of Medicine; and
| | - Se Hoon Kim
- 3Brain Tumor Center and
- 4Pathology, and
- 6Brain Research Institute, Yonsei University Health System, Yonsei University College of Medicine; and
| | - Chang-Ok Suh
- 3Brain Tumor Center and
- 5Radiation Oncology, Severance Hospital, Yonsei University College of Medicine
| | - Sun Ho Kim
- 2Neurosurgery
- 3Brain Tumor Center and
- 6Brain Research Institute, Yonsei University Health System, Yonsei University College of Medicine; and
| | - Kyu-Sung Lee
- 6Brain Research Institute, Yonsei University Health System, Yonsei University College of Medicine; and
- 7Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Jong Hee Chang
- 2Neurosurgery
- 3Brain Tumor Center and
- 6Brain Research Institute, Yonsei University Health System, Yonsei University College of Medicine; and
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11
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Kim BS, Kim Y, Kong DS, Nam DH, Lee JI, Suh YL, Seol HJ. Clinical outcomes of intracranial solitary fibrous tumor and hemangiopericytoma: analysis according to the 2016 WHO classification of central nervous system tumors. J Neurosurg 2018; 129:1384-1396. [PMID: 29372881 DOI: 10.3171/2017.7.jns171226] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/14/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors conducted this retrospective study to investigate the clinical outcomes of intracranial solitary fibrous tumor (SFT) and hemangiopericytoma (HPC), defined according to the 2016 WHO classification of central nervous system (CNS) tumors.METHODSHistopathologically proven intracranial SFT and HPC cases treated in the period from June 1996 to September 2014 were retrospectively reviewed and analyzed. Two neuropathologists reviewed pathological slides and regraded the specimens according to the 2016 WHO classification. Factors associated with progression-free survival (PFS) and overall survival (OS) were statistically evaluated with uni- and multivariate analyses.RESULTSThe records of 47 patients-10 with SFT, 33 with HPC, and 4 with anaplastic HPC-were reviewed. A malignant transition from conventional SFT to WHO grade III SFT/HPC was observed in 2 cases, and 13 HPC cases were assigned grade III SFT/HPC. Mean and median follow-ups were 114.6 and 94.7 months, respectively (range 7.1-366.7 months). Gross-total resection (GTR) was significantly associated with longer PFS and OS (p = 0.012 for both), and adjuvant radiation therapy versus no such therapy led to significantly longer PFS (p = 0.018). Extracranial metastases to the liver, bone, lung, spine, and kidney occurred in 10 patients (21.3%). Grade III SFT/HPC was strongly correlated with the development of extracranial metastases (p = 0.031).CONCLUSIONSThe 2016 WHO classification of CNS tumors reflected the different types of pathological malignant progression and clinical outcomes better than prior classifications. Gross-total resection should be the primary treatment goal in patients with SFT/HPC, regardless of the pathological grade, and radiation can be administered as adjuvant therapy for patients with SFT/HPC that shows an aggressive phenotype or that is not treated with GTR.
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Affiliation(s)
- Byung Sup Kim
- 1Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan
| | - Yuil Kim
- 2Department of Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul; and
| | | | | | | | - Yeon-Lim Suh
- 4Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ratneswaren T, Hogg FRA, Gallagher MJ, Ashkan K. Surveillance for metastatic hemangiopericytoma-solitary fibrous tumors-systematic literature review on incidence, predictors and diagnosis of extra-cranial disease. J Neurooncol 2018; 138:447-467. [PMID: 29551003 DOI: 10.1007/s11060-018-2836-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/07/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intracranial hemangiopericytomas (HPC) and solitary fibrous tumors (SFTs) (HPC-SFT) are rare vascular tumors that resemble meningioma on imaging and predominantly affect young adults. HPC-SFT have a high rate of local recurrence with well-known propensity for extracranial metastases. This provides clinical dilemmas frequently encountered in oncology: (i) How should these patients be monitored long term? (ii) Which primary tumors are more likely to metastasize? OBJECTIVES This systematic review aims to identify the incidence, common locations and time to presentation of extra-cranial metastases of HPC-SFT. We will assess the effect of primary tumor location, treatment, grade, patient age, gender and effect of local recurrence on rates of extra-cranial metastasis and discuss the ideal techniques by which patients with intracranial HPC-SFT should be monitored for extra-cranial metastases. METHODS Using PRISMA guidelines the authors searched Pubmed. Search terms included hemangiopericytoma, HPC, solitary fibrous tumor/ tumour, SFT, HPC-SFT, extra-cranial metastases, metastases, recurrence, monitoring, follow-up. Studies were identified up to 1st February 2018. Reference lists of identified articles were reviewed to detect other relevant citations. Data were extracted using a standard data collection form and results organized into (i) general study/patient characteristics, (ii) location of extra-cranial metastases, (iii) methods by which metastases were detected and followed up and (iv) characteristics of primary tumors. RESULTS Seventy-one studies were identified. Mean recorded follow up ranged from 4 to 312 months. Mean age at diagnosis was 42.0 years. The overall rate of extra-cranial metastasis was 28% (n = 251/904). The minimum time to extracranial metastases was 3 months and the maximum time was 372 months. In the 71 studies identified, where site of extra-cranial metastasis was specified, there were 347 metastases in 213 patients. The most common sites for metastases were bone (location not specified) (19.6%) followed by lung and pleura (18.4%), liver (17.6%), and vertebrae (14.1%). Extra-cranial metastatic disease is typically diagnosed following symptomatic presentation. There is little documentation of methods used to monitor patients with extra-cranial HPC-SFT and no clear surveillance paradigm observed. Higher primary tumor grade (WHO Grade III) was associated with a 1.88 (p = 0.016) increased risk of extra-cranial metastasis. Location and treatment of primary tumor, local recurrence, patient age and gender were not. CONCLUSION Patients with intracranial HPC-SFT require periodic, long term monitoring for extra-cranial metastases. Metastases occur in any age group and can occur early and late. They vary in location and are typically diagnosed following symptomatic presentation. There is no suggested imaging modality for surveillance. Higher grade primary tumors have a greater risk of metastasis. Regular clinical review is essential with early imaging for symptoms of recurrence/metastasis with imaging modality dependent on clinical concern. Quality evidence for an imaging surveillance protocol in this heterogeneous group of patients is lacking. A multicenter study on appropriate surveillance may be of benefit.
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Affiliation(s)
- Tarini Ratneswaren
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK.
| | - Florence Rosie Avila Hogg
- Department of Neurosurgery, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK
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