Management of recurrent intracranial hemangiopericytoma

Brain Tumor Research Center, Department of Neurological Surgery, University of California - San Francisco, San Francisco, CA 94143, USA.
Journal of Clinical Neuroscience (Impact Factor: 1.32). 09/2011; 18(11):1500-4. DOI: 10.1016/j.jocn.2011.04.009
Source: PubMed

ABSTRACT Intracranial hemangiopericytoma (HPC) is an aggressive meningothelial neoplasm. A particularly challenging aspect of management of patients with HPC is optimizing treatment for recurrence, progression, and extracranial metastasis. Here we describe a modern cohort of patients with recurrent HPC to better understand treatment strategies that may improve outcome. Patients managed at UCSF for recurrent intracranial HPC were compiled into a single database based on a retrospective review of patient records, including operative, radiologic, and clinic reports. Cox regression was performed to determine factors that independently predicted treatment outcomes. At UCSF, 14 patients with available treatment and follow-up data were seen for management of HPC recurrence. Eight patients underwent repeat surgical resection, of whom four received adjuvant external beam radiotherapy (EBRT), one received additional Gamma Knife radiosurgery (GKS), and one received brachytherapy. Radiosurgical intervention alone was utilized for recurrence in six patients, with four receiving GKS and two receiving CyberKnife. Nine patients suffered a second recurrence at a median time of 3.5 years following reintervention. Nine patients died following reintervention, with a median survival of 7.9 years following intervention for recurrence. In univariate analysis, factors associated with increased time to second recurrence included non-posterior fossa location (log rank, p < 0.05) and surgical resection with adjuvant EBRT (log rank, p < 0.05). The addition of adjuvant EBRT to surgical resection similarly extended overall survival compared to surgical resection alone (log rank, p < 0.05). GKS was associated with earlier second recurrence compared to surgically based strategies (log rank, p < 0.05). We conclude that when combined with surgical resection, EBRT appears promising in the extension of second recurrence-free survival and overall survival. This multimodality approach also appears to outperform GKS in extending time to second recurrence. Accordingly, when safe and feasible, surgical resection of recurrent HPC with adjuvant EBRT should be the first steps in management.

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    ABSTRACT: BACKGROUND:: Intracranial hemangiopericytoma (HPC) is a rare malignancy for which treatment recommendations vary. OBJECTIVE:: To characterize outcomes of HPC patients treated with post-operative external beam radiotherapy (PORT). METHODS:: A retrospective analysis was conducted utilizing the Surveillance, Epidemiology and End Results (SEER) Program of the United States National Cancer Institute. We identified patients with intracranial hemangiopericytoma who underwent surgery alone (SO) or PORT. RESULTS:: We identified 88 patients diagnosed between 1982 and 2009 with HPC treated with SO or PORT. The majority was female (53%) and white (84%) with a median age of 50.5 years (range 0-92). Gross total resection (GTR) was achieved in 55% and PORT was delivered to 48% of the entire cohort. Median overall survival (OS) and cause-specific survival (CSS) were 111 months and 161 months, respectively. On univariate analysis, age > 50 years correlated with poor OS (HR 3.43 [1.70-6.95]; p=0.001) and CSS (HR 2.77 [1.18-6.48]; p=0.019). On multivariate analysis (MVA), age > 50 years correlated with poor OS (HR 3.69 [1.72-7.93]; p=0.001) and CSS (HR 2.67 [1.08-6.59]; p=0.034). On MVA, GTR correlated with improved OS (HR 0.28 [0.11-0.71]; p=0.007) and CSS (HR 0.23 [0.07-0.76]; p=0.016). In addition, PORT correlated with improved OS (MVA HR 0.02 [0.00-0.31]; p=0.005) and CSS (MVA HR 0.02 [0.00-0.45]; p=0.015). Patients undergoing STR with PORT compared favorably with those undergoing GTR alone with respect to OS (HR 0.43 [0.15-1.26], p=0.13) and CSS (HR 0.51 [0.15-1.78], p=0.29). CONCLUSION:: In intracranial HPC, both PORT and GTR independently correlate with improved OS and CSS.
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