Management of recurrent intracranial hemangiopericytoma
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: Objective To design and assess the quality of a novel lateral retrocanthal endoscopic approach to the lateral cavernous sinus. DesignComputer modeling software was used to optimize the geometry of the surgical pathway, which was confirmed on cadaver specimens. We calculated trajectories and surgically accessible areas to the middle fossa while applying a constraint on the amount of soft tissue retraction. SettingVirtual computer model to simulate the surgical approach and cadaver laboratory. ParticipantsThe authors. Main Outcome MeasuresAdequate surgical access to the lateral cavernous sinus and adjacent regions as determined by operations on the cadaver specimens. Additionally, geometric limitations were imposed as determined by the model so that retraction on soft tissue structures was maintained at a clinically safe distance. ResultsOur calculations revealed adequate access to the lateral cavernous sinus, Meckel cave, orbital apex, and middle fossa floor. Cadaveric testing revealed sufficient access to these areas using <10mm of orbital retraction. Conclusions Our study validates not only the use of computer simulation to plan operative approaches but the feasibility of the lateral retrocanthal approach to the lateral cavernous sinus.02/2014; 75(1):11-7. DOI:10.1055/s-0033-1353363
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ABSTRACT: Stereotactic body radiation therapy (SBRT) concentrates radiation to a predefined target, affecting all the cells within it. Adoptive immunotherapy is not restricted by the major histocompatibility complex (MHC) in recognizing and eliminating target cells. We investigated the effects of the combined modality of SBRT and adoptive immunotherapy on patients with advanced malignant tumors. The database of 316 patients with 845 tumors who underwent SBRT between April, 2010 and February, 2012 was retrospectively reviewed. Of the 316 patients, 145 received biological immunotherapy and were assigned into the observation group, whereas the remaining patients constituted the control group. Patients in the two groups were recorded on efficacy assessment, Karnofsky performance status (KPS), cell phenotype expression level in vitro and the percentages of lymphocyte subsets and ratio of CD4(+)/CD8(+) lymphocytes in the peripheral blood. Following treatment, the total effectiveness [complete response (CR) + partial response (PR)], the KPS score, the percentages of lymphocyte subsets and the CD4(+)/CD8(+) lymphocyte ratio in the observation group were higher compared to those in the control group, with a statistically significant difference (P<0.05). The expression of CD3(+) and CD3(+)CD56(+) cytokine-induced killer (CIK) cells were increased from 56.76±4.54% and 11.32±2.96% to 94.67±4.46% and 32.65±1.12%, respectively, when cultured in vitro (P<0.01). The percentages of lymphocyte subsets and the CD4(+)/CD8(+) lymphocyte ratio were significantly increased compared to prior to treatment in the observation group (P<0.05). SBRT combined with adoptive immunotherapy may be a novel therapeutic option for patients with advanced malignant tumors.Molecular and Clinical Oncology 09/2013; 1(5):925-929. DOI:10.3892/mco.2013.157
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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.Neurosurgery 11/2012; 72(2). DOI:10.1227/NEU.0b013e31827b9e68 · 3.03 Impact Factor