Single Fraction Stereotactic Radiosurgery of Meningeal Hemangiopericytomas

Abstract

Purpose/Objective(s)Meningeal hemangiopericytomas (M-HPC) are challenging tumors with a high rate of recurrence despite surgical resection and external beam radiation therapy (EBRT). To better understand the role of single-fraction stereotactic radiosurgery (SRS), we reviewed our experience from 1990 until 2010.Materials/MethodsRetrospective review of 22 patients. Twelve patients (55%) underwent a single SRS procedure, whereas 10 patients (45%) had more than one SRS procedure (range, 2-6). In total, 47 SRS procedures were performed to treat 64 tumors. Fourteen patients (64%) had undergone prior EBRT (median dose, 56.0 Gy). Follow-up after the initial SRS (median, 66 months) was censored at the time of death (n = 15) or last clinical evaluation (n = 7).ResultsEleven patients (50%) died of intracranial tumor progression (n = 10) or treatment-related complications (n = 1). One patient (5%) died of systemic disease progression. Disease-specific survival (DSS) at 1-year, 3-years and 5-years was 96%, 82%, and 61%, respectively. Prior EBRT (HR = 9.0, 95% CI = 1.1-78.1, P < 0.05) and larger initial tumor volume (HR = 1.09, 95% CI = 1.02-1.2, P = 0.02) were associated with worse DSS. Local tumor control (LTC) at 1-, 3-, and 5-years was 89%, 68%, and 59%, respectively. Improved LTC was noted in patients who had not undergone prior EBRT (HR = 6.3, 95% CI = 2.1-19.5, P = 0.001). One patient (5%) had symptomatic radiation-relation complications after SRS.ConclusionsSingle-fraction SRS provided an acceptable rate of LTC for patients with recurrent or residual M-HPC. Repeat SRS is often required secondary to either distant or local tumor progression. Purpose/Objective(s)Meningeal hemangiopericytomas (M-HPC) are challenging tumors with a high rate of recurrence despite surgical resection and external beam radiation therapy (EBRT). To better understand the role of single-fraction stereotactic radiosurgery (SRS), we reviewed our experience from 1990 until 2010. Meningeal hemangiopericytomas (M-HPC) are challenging tumors with a high rate of recurrence despite surgical resection and external beam radiation therapy (EBRT). To better understand the role of single-fraction stereotactic radiosurgery (SRS), we reviewed our experience from 1990 until 2010. Materials/MethodsRetrospective review of 22 patients. Twelve patients (55%) underwent a single SRS procedure, whereas 10 patients (45%) had more than one SRS procedure (range, 2-6). In total, 47 SRS procedures were performed to treat 64 tumors. Fourteen patients (64%) had undergone prior EBRT (median dose, 56.0 Gy). Follow-up after the initial SRS (median, 66 months) was censored at the time of death (n = 15) or last clinical evaluation (n = 7). Retrospective review of 22 patients. Twelve patients (55%) underwent a single SRS procedure, whereas 10 patients (45%) had more than one SRS procedure (range, 2-6). In total, 47 SRS procedures were performed to treat 64 tumors. Fourteen patients (64%) had undergone prior EBRT (median dose, 56.0 Gy). Follow-up after the initial SRS (median, 66 months) was censored at the time of death (n = 15) or last clinical evaluation (n = 7). ResultsEleven patients (50%) died of intracranial tumor progression (n = 10) or treatment-related complications (n = 1). One patient (5%) died of systemic disease progression. Disease-specific survival (DSS) at 1-year, 3-years and 5-years was 96%, 82%, and 61%, respectively. Prior EBRT (HR = 9.0, 95% CI = 1.1-78.1, P < 0.05) and larger initial tumor volume (HR = 1.09, 95% CI = 1.02-1.2, P = 0.02) were associated with worse DSS. Local tumor control (LTC) at 1-, 3-, and 5-years was 89%, 68%, and 59%, respectively. Improved LTC was noted in patients who had not undergone prior EBRT (HR = 6.3, 95% CI = 2.1-19.5, P = 0.001). One patient (5%) had symptomatic radiation-relation complications after SRS. Eleven patients (50%) died of intracranial tumor progression (n = 10) or treatment-related complications (n = 1). One patient (5%) died of systemic disease progression. Disease-specific survival (DSS) at 1-year, 3-years and 5-years was 96%, 82%, and 61%, respectively. Prior EBRT (HR = 9.0, 95% CI = 1.1-78.1, P < 0.05) and larger initial tumor volume (HR = 1.09, 95% CI = 1.02-1.2, P = 0.02) were associated with worse DSS. Local tumor control (LTC) at 1-, 3-, and 5-years was 89%, 68%, and 59%, respectively. Improved LTC was noted in patients who had not undergone prior EBRT (HR = 6.3, 95% CI = 2.1-19.5, P = 0.001). One patient (5%) had symptomatic radiation-relation complications after SRS. ConclusionsSingle-fraction SRS provided an acceptable rate of LTC for patients with recurrent or residual M-HPC. Repeat SRS is often required secondary to either distant or local tumor progression. Single-fraction SRS provided an acceptable rate of LTC for patients with recurrent or residual M-HPC. Repeat SRS is often required secondary to either distant or local tumor progression.