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: 1.38).
09/2011; 18(11):1500-4. DOI: 10.1016/j.jocn.2011.04.009
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.
Available from: PubMed Central
- "Palliative treatment is often applied to patients with high-risk or malignant tumors due to their ineligibility for surgery and conventional radiation or chemotherapy (10,11). In the past, patients with inoperable advanced malignant tumor were chiefly referred for traditional radiation therapy which exerted a profound toxic effect on the surrounding tissues and was likely to raise the risk of recurrence or further deterioration. "
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ABSTRACT: A 34-year-old male who had a hemangiopericytoma (HPC) within the trigone of right lateral ventricle presented with headache, disorientated consciousness and blurred vision. Computed tomography and magnetic resonance images revealed with homogenous contrast enhancement a 5 cm × 4.5 cm × 4.2 cm lesion within the trigone of right lateral ventricle. Angiographic study revealed a highly vascularized lesion fed from right anterior choroid artery anteriorly and right medial posterior choroid artery posteriorly. The tumor was grossly totally removed via right temporal gyrus. The immunohistochemical study was consistent with HPC. Differential diagnosis of HPC from meningioma and solitary fibrous tumor is crucial because of the high tendency of local recurrence and mestatasis of HPCs. Immunohistochemical study is a very valuable method to confirm the diagnosis of HPCs. Complete surgical resection and/or postoperative radiotherapy and/or radiosurgery were beneficial to long-term tumor control. Due to a prolonged time interval between surgery and local recurrence or metastasis, extensive follow-up to rule out local recurrences and delayed extracranial metastases is warranted.
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