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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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Swaminathan S, Ruzevick J, Venur V, Halasz LM, Rockhill J, Gonzalez-Cuyar L, Cranmer LD, Ferreira Jnr M. Intracranial Solitary Fibrous Tumor/Hemangiopericytoma Treated with Microsurgical Resection: Retrospective Cohort Analysis of a Single-Center Experience. Ther Clin Risk Manag 2022; 18:901-912. [PMID: 36092453 PMCID: PMC9462835 DOI: 10.2147/tcrm.s375064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To provide benchmarks for further studies of solitary fibrous tumor/hemangiopericytoma (SFT/HPC) of the central nervous system (CNS), we investigated the association of baseline demographic, clinico-pathologic, and treatment factors with outcomes in those treated at our center. Methods We conducted a retrospective, cohort analysis of patients treated for SFT/HPC at the University of Washington 1990–2020. Kaplan-Meier and univariable Cox analyses assessed relationships between baseline variables and local or global CNS recurrence, extraneural recurrence, progression-free survival (PFS) and overall survival (OS). Results Among 34 eligible patients, median duration of follow-up was 79 months (range 13–318 months). Local and global CNS recurrence occurred at a median of 81 m (95% CI 48–151) and 81 m (95% CI 47–112), respectively. Extraneural metastases occurred at a median 248 m (95% CI 180-Not Reached) and only in grade 3 tumors. Median PFS and OS were 76 months (95% CI: 47–109 months) and 210 months (95% CI 131–306 months), respectively. Univariable Cox analyses showed that age at diagnosis was associated with local (p = 0.01) and global CNS relapse (p = 0.01), and PFS (p = 0.03). Gross total resection was associated with decreased local or global CNS relapse (p = 0.02) and improved PFS (p = 0.03); peri-operative radiation was associated with decreased local CNS relapse (p = 0.02). Conclusion Following microsurgical resection of SFT/HPC, CNS relapse is common and associated with age, extent of resection, and adjuvant radiation. Extraneural relapse occurs in some patients. Delayed time-to-initial relapse justifies prolonged surveillance, but optimal approaches have not been defined.
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Affiliation(s)
- Shreya Swaminathan
- Department of Neurological Surgery, The University of Washington School of Medicine, Seattle, WA, USA
| | - Jacob Ruzevick
- Department of Neurological Surgery, The University of Washington School of Medicine, Seattle, WA, USA
| | - Vyshak Venur
- Division of Medical Oncology, Department of Medicine, The University of Washington School of Medicine, Seattle, WA, USA
| | - Lia M Halasz
- Department of Radiation Oncology, The University of Washington School of Medicine, Seattle, WA, USA
| | - Jason Rockhill
- Department of Radiation Oncology, The University of Washington School of Medicine, Seattle, WA, USA
| | - Luis Gonzalez-Cuyar
- Department of Laboratory Medicine and Pathology, Division of Neuropathology, The University of Washington School of Medicine, Seattle, WA, USA
| | - Lee D Cranmer
- Division of Medical Oncology, Department of Medicine, The University of Washington School of Medicine, Seattle, WA, USA
| | - Manuel Ferreira Jnr
- Department of Neurological Surgery, The University of Washington School of Medicine, Seattle, WA, USA
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