Cancer Res Treat.  2022 Jan;54(1):65-74. 10.4143/crt.2021.142.

The Role of Postoperative Radiotherapy in Intracranial Solitary Fibrous Tumor/Hemangiopericytoma: A Multi-institutional Retrospective Study (KROG 18-11)

• Lee JH
• Jeon SH
• Park CK
• Park SH
• Yoon HI
• Chang JH
• Suh CO
• Kang SJ
• Lim DH
• Kim IA
• Kim JH
• Im JH
• Kim SH
• Wee CW
• Kim IH

• KMID: 2524588
• DOI: http://doi.org/10.4143/crt.2021.142

Abstract

Purpose
This study aimed to evaluate the role of postoperative radiotherapy (PORT) in intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC).
Materials and Methods
A total of 133 patients with histologically confirmed HPC were included from eight institutions. Gross total resection (GTR) and subtotal resection (STR) were performed in 86 and 47 patients, respectively. PORT was performed in 85 patients (64%). The prognostic effects of sex, age, performance, World Health Organization (WHO) grade, location, size, Ki-67, surgical extent, and PORT on local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) were estimated by univariate and multivariate analyses.
Results
The 10-year PFS, and OS rates were 45%, and 71%, respectively. The multivariate analysis suggested that PORT significantly improved LC (p < 0.001) and PFS (p < 0.001). The PFS benefit of PORT was maintained in the subgroup of GTR (p=0.001), WHO grade II (p=0.001), or STR (p < 0.001). In the favorable subgroup of GTR and WHO grade II, PORT was also significantly related to better PFS (p=0.028). WHO grade III was significantly associated with poor DMFS (p=0.029). In the PORT subgroup, the 0-0.5 cm margin of the target volume showed an inferior LC to a large margin with 1.0-2.0 cm (p=0.021). Time-dependent Cox proportion analysis showed that distant failures were significantly associated with poor OS (p=0.003).
Conclusion
This multicenter study supports the role of PORT in disease control of intracranial SFT/HPC, irrespective of the surgical extent and grade. For LC, PORT should enclose the tumor bed with sufficient margin.

Keyword

Hemangiopericytoma; Solitary fibrous tumor; Intracranial; Radiotherapy; Margin; Postoperative

Figure

• 

  Fig. 1 Disease control rate related to postoperative radiotherapy (PORT). Progression-free survival (A) and local control rate (B) in all patients. Progression-free survival (C) and local control rate (D) in the patients with World Health Organization grade II after gross total resection.

• 

  Fig. 2 Disease control rate according to the surgical extent and RT: (A) progression-free survival and (B) local control rate. GTR, gross total resection; PORT, postoperative radiotherapy; RT, radiotherapy; STR, subtotal resection.

• 

  Fig. 3 Local control rate according to the margin of clinical target volume in the subgroup undergoing postoperative radiotherapy.

Reference

References

1. Stout AP, Murray MR. Hemangiopericytoma: a vascular tumor featuring Zimmermann’s pericytes. Ann Surg. 1942; 116:26–33.

2. Dho YS, Jung KW, Ha J, Seo Y, Park CK, Won YJ, et al. An updated nationwide epidemiology of primary brain tumors in Republic of Korea, 2013. Brain Tumor Res Treat. 2017; 5:16–23.

3. Kim JH, Jung HW, Kim YS, Kim CJ, Hwang SK, Paek SH, et al. Meningeal hemangiopericytomas: long-term outcome and biological behavior. Surg Neurol. 2003; 59:47–53.

4. Ghia AJ, Chang EL, Allen PK, Mahajan A, Penas-Prado M, McCutcheon IE, et al. Intracranial hemangiopericytoma: patterns of failure and the role of radiation therapy. Neurosurgery. 2013; 73:624–30.

5. Ghia AJ, Allen PK, Mahajan A, Penas-Prado M, McCutcheon IE, Brown PD. Intracranial hemangiopericytoma and the role of radiation therapy: a population based analysis. Neurosurgery. 2013; 72:203–9.

6. Sonabend AM, Zacharia BE, Goldstein H, Bruce SS, Hershman D, Neugut AI, et al. The role for adjuvant radiotherapy in the treatment of hemangiopericytoma: a Surveillance, Epidemiology, and End Results analysis. J Neurosurg. 2014; 120:300–8.

7. Vuorinen V, Sallinen P, Haapasalo H, Visakorpi T, Kallio M, Jaaskelainen J. Outcome of 31 intracranial haemangiopericytomas: poor predictive value of cell proliferation indices. Acta Neurochir (Wien). 1996; 138:1399–408.

8. Guthrie BL, Ebersold MJ, Scheithauer BW, Shaw EG. Meningeal hemangiopericytoma: histopathological features, treatment, and long-term follow-up of 44 cases. Neurosurgery. 1989; 25:514–22.

9. Stessin AM, Sison C, Nieto J, Raifu M, Li B. The role of postoperative radiation therapy in the treatment of meningeal hemangiopericytoma-experience from the SEER database. Int J Radiat Oncol Biol Phys. 2013; 85:784–90.

10. Rutkowski MJ, Jian BJ, Bloch O, Chen C, Sughrue ME, Tihan T, et al. Intracranial hemangiopericytoma: clinical experience and treatment considerations in a modern series of 40 adult patients. Cancer. 2012; 118:1628–36.

11. Zhu H, Duran D, Hua L, Tang H, Chen H, Zhong P, et al. Prognostic factors in patients with primary hemangiopericytomas of the central nervous system: a series of 103 cases at a single institution. World Neurosurg. 2016; 90:414–9.

12. Jeon SH, Park SH, Kim JW, Park CK, Paek SH, Kim IH. Efficacy of adjuvant radiotherapy in the intracranial hemangiopericytoma. J Neurooncol. 2018; 137:567–73.

13. Lee EJ, Kim JH, Park ES, Khang SK, Cho YH, Hong SH, et al. The impact of postoperative radiation therapy on patterns of failure and survival improvement in patients with intracranial hemangiopericytoma. J Neurooncol. 2016; 127:181–90.

14. Rutkowski MJ, Sughrue ME, Kane AJ, Aranda D, Mills SA, Barani IJ, et al. Predictors of mortality following treatment of intracranial hemangiopericytoma. J Neurosurg. 2010; 113:333–9.

15. Schiariti M, Goetz P, El-Maghraby H, Tailor J, Kitchen N. Hemangiopericytoma: long-term outcome revisited. Clinical article. J Neurosurg. 2011; 114:747–55.

16. Sung KS, Moon JH, Kim EH, Kang SG, Kim SH, Suh CO, et al. Solitary fibrous tumor/hemangiopericytoma: treatment results based on the 2016 WHO classification. J Neurosurg. 2019; 130:418–25.

17. Melone AG, D’Elia A, Santoro F, Salvati M, Delfini R, Cantore G, et al. Intracranial hemangiopericytoma: our experience in 30 years: a series of 43 cases and review of the literature. World Neurosurg. 2014; 81:556–62.

18. Kano H, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD. Adjuvant stereotactic radiosurgery after resection of intracranial hemangiopericytomas. Int J Radiat Oncol Biol Phys. 2008; 72:1333–9.

19. Olson C, Yen CP, Schlesinger D, Sheehan J. Radiosurgery for intracranial hemangiopericytomas: outcomes after initial and repeat Gamma Knife surgery. J Neurosurg. 2010; 112:133–9.

20. Copeland WR, Link MJ, Stafford SL, Pollock BE. Single-fraction stereotactic radiosurgery of meningeal hemangiopericytomas. J Neurooncol. 2014; 120:95–102.

21. Kim JW, Kim DG, Chung HT, Paek SH, Kim YH, Han JH, et al. Gamma Knife stereotactic radiosurgery for intracranial hemangiopericytomas. J Neurooncol. 2010; 99:115–22.

22. Kano H, Shuto T, Iwai Y, Sheehan J, Yamamoto M, McBride HL, et al. Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective international outcome study. J Neurosurg. 2015; 122:1469–78.

23. Cohen-Inbar O, Lee CC, Mousavi SH, Kano H, Mathieu D, Meola A, et al. Stereotactic radiosurgery for intracranial hemangiopericytomas: a multicenter study. J Neurosurg. 2017; 126:744–54.

24. Martin-Broto J, Stacchiotti S, Lopez-Pousa A, Redondo A, Bernabeu D, de Alava E, et al. Pazopanib for treatment of advanced malignant and dedifferentiated solitary fibrous tumour: a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2019; 20:134–44.

25. Soyuer S, Chang EL, Selek U, McCutcheon IE, Maor MH. Intracranial meningeal hemangiopericytoma: the role of radiotherapy: report of 29 cases and review of the literature. Cancer. 2004; 100:1491–7.

26. Fountas KN, Kapsalaki E, Kassam M, Feltes CH, Dimopoulos VG, Robinson JS, et al. Management of intracranial meningeal hemangiopericytomas: outcome and experience. Neurosurg Rev. 2006; 29:145–53.

27. Park MS, Patel SR, Ludwig JA, Trent JC, Conrad CA, Lazar AJ, et al. Activity of temozolomide and bevacizumab in the treatment of locally advanced, recurrent, and metastatic hemangiopericytoma and malignant solitary fibrous tumor. Cancer. 2011; 117:4939–47.

28. Schweizer L, Koelsche C, Sahm F, Piro RM, Capper D, Reuss DE, et al. Meningeal hemangiopericytoma and solitary fibrous tumors carry the NAB2-STAT6 fusion and can be diagnosed by nuclear expression of STAT6 protein. Acta Neuropathol. 2013; 125:651–8.

29. Robinson DR, Wu YM, Kalyana-Sundaram S, Cao X, Lonigro RJ, Sung YS, et al. Identification of recurrent NAB2-STAT6 gene fusions in solitary fibrous tumor by integrative sequencing. Nat Genet. 2013; 45:180–5.

30. Ciliberti MP, D’Agostino R, Gabrieli L, Nikolaou A, Sardaro A. The radiation therapy options of intracranial hemangiopericytoma: an overview and update on a rare vascular mesenchymal tumor. Oncol Rev. 2018; 12:354.