Intracranial Hemangiopericytoma: Patterns of Failure and the Role of Radiation Therapy
Neurosurgery - Current Issue
BACKGROUND:Meningeal hemangiopericytoma (M-HPC) is a rare entity. OBJECTIVE:To characterize our institutional experience in treating M-HPC. METHODS:We reviewed the medical records of patients with M-HPC evaluated at The University of Texas M.D. Anderson Cancer Center between 1979 and 2009. RESULTS:We identified 63 patients diagnosed between 1979 and 2009 with M-HPC treated with surgery alone or with postoperative radiotherapy (PORT). The majority were male (59%) and with a median age of 40.9 years (range, 0-71). Gross total resection (GTR) predominated (n = 31, 49%) followed by subtotal resection (n = 23, 37%) and unknown status (n = 9, 14.3%). PORT was delivered to 39 of the 63 patients (62%). The 5-, 10-, and 15-year overall survival were 90%, 68%, and 28%, respectively. The 5-, 10-, and 15-year local control (LC) were 70%, 37%, and 20%, respectively. The 5-, 10-, and 15-year metastasis-free survival were 85%, 39%, and 7%. PORT resulted in improved LC (hazard ratio [HR] 0.38, P = .008). Radiotherapy (RT) dose ≥60 Gy correlated with improved LC relative to <60 Gy (HR 0.12, P = .045). GTR correlated with improved LC (HR 0.40, P = .03). On multivariate analysis, PORT (HR 0.33, P = .003), GTR (HR = 0.33, P = .008), and RT dose ≥60 Gy (HR 0.33, P = .003) correlated with improved LC. Among those with GTR, PORT resulted in improved LC (HR 0.18, P = .027). Extent of resection and PORT did not correlate with improved overall survival. CONCLUSION:In M-HPC, both PORT and GTR independently correlate with improved LC. PORT improves LC following GTR. We recommend RT dose ≥60 Gy to optimize LC. ABBREVIATIONS:BED, biologically equivalent doseCSS, cause-specific survivalHPC, hemangiopericytomasLC, local controlMFS, metastasis-free survivalM-HPC, meningeal hemangiopericytomaMVA, multivariate analysisOS, overall survivalPORT, postoperative radiotherapyRFS, recurrence-free survivalRT, radiotherapySTR, subtotal resectionOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2013/10000/Intracranial_Hemangiopericytoma___Patterns_of.16.aspx
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