Primary Intracranial Hemangiopericytomas: Recurrence, Metastasis, and Radiotherapy

• Main Authors: Patel, Ankur R., Flores, Bruno C., Mickey, Bruce E., Barnett, Samuel L.
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0036-1592591

Introduction: Intracranial hemangiopericytomas (HPC) are rare tumors with a clinical course characterized by high rates of recurrence and metastasis to extracranial sites. Radiotherapy has become an important adjunct to surgical resection, but the timing of radiation therapy and cohort of patients most likely to benefit remains unclear. Methods: A retrospective review of patients treated at the University of Texas Southwestern Medical Center with HPC between 1985 and 2014 was conducted, which yielded 20 patients with adequate follow-up. Rates of recurrence, metastasis and overall survival were assessed. Kaplan-Meier and Cox regression analysis was performed. Results: The average age of the patients was 45.6 years. Thirteen patients underwent gross total resection while 5 patients underwent subtotal resection. Clinical follow-up ranged from 8 to 357 months with a mean follow-up of 122 months. Eleven patients (55%) developed tumor recurrence during the follow-up period at an average of 62 months. The 5-, 10-, and 15-year recurrence free survival (RFS) rates were 61, 41, and 20%, respectively. Six patients (30%) had tumor metastasis at an average of 113 months. The 5-, 10-, and 15-year metastasis-free survival rates were 94, 73, and 59%, respectively. Of the 11 patients with tumor recurrence, 2 patients underwent repeat surgery alone, 4 patients underwent radiotherapy alone, and 5 patients underwent surgery and radiotherapy. Overall survival at last follow-up was 75%. Importantly, immediate post-operative adjuvant radiotherapy (IRT) was not associated with increased recurrence free survival compared with surgery alone. Furthermore, IRT did not significantly improve overall survival compared with delayed radiotherapy at the time of recurrence (DRT). Conclusion: High rates of recurrence necessitate that patients with HPCs be monitored with close clinical and radiographic follow-up. At initial presentation, for diagnostic and therapeutic benefit, maximally safe surgical resection remains the mainstay treatment modality. While HPCs have been shown to be radiosensitive, there was no survival benefit to IRT compared with DRT in this cohort. As a result, an individualized treatment strategy is necessary and may involve further surgery, radiotherapy, chemotherapy, or combination therapy.