Stereotactic radiosurgery for intracranial hemangiopericytomas: a multicenter study

Restricted access

OBJECTIVE

Hemangiopericytomas (HPCs) are rare tumors widely recognized for their aggressive clinical behavior, high recurrence rates, and distant and extracranial metastases even after a gross-total resection. The authors report a large multicenter study, through the International Gamma Knife Research Foundation (IGKRF), reviewing management and outcome following stereotactic radiosurgery (SRS) for recurrent or newly discovered HPCs.

METHODS

Eight centers participating in the IGKRF participated in this study. A total of 90 patients harboring 133 tumors were identified. Patients were included if they had a histologically diagnosed HPC managed with SRS during the period 1988–2014 and had a minimum of 6 months' clinical and radiological follow-up. A de-identified database was created. The patients' median age was 48.5 years (range 13–80 years). Prior treatments included embolization (n = 8), chemotherapy (n = 2), and fractionated radiotherapy (n = 34). The median tumor volume at the time of SRS was 4.9 cm3 (range 0.2–42.4 cm3). WHO Grade II (typical) HPCs formed 78.9% of the cohort (n = 71). The median margin and maximum doses delivered were 15 Gy (range 2.8–24 Gy) and 32 Gy (range 8–51 Gy), respectively. The median clinical and radiographic follow-up periods were 59 months (range 6–190 months) and 59 months (range 6–183 months), respectively. Prognostic variables associated with local tumor control and post-SRS survival were evaluated using Cox univariate and multivariate analysis. Actuarial survival after SRS was analyzed using the Kaplan-Meier method.

RESULTS

Imaging studies performed at last follow-up demonstrated local tumor control in 55% of tumors and 62.2% of patients. New remote intracranial tumors were found in 27.8% of patients, and 24.4% of patients developed extracranial metastases. Adverse radiation effects were noted in 6.7% of patients. During the study period, 32.2% of the patients (n = 29) died. The actuarial overall survival was 91.5%, 82.1%, 73.9%, 56.7%, and 53.7% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. Local progression–free survival (PFS) was 81.7%, 66.3%, 54.5%, 37.2%, and 25.5% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. In our cohort, 32 patients underwent 48 repeat SRS procedures for 76 lesions. Review of these 76 treated tumors showed that 17 presented as an in-field recurrence and 59 were defined as an out-of-field recurrence. Margin dose greater than 16 Gy (p = 0.037) and tumor grade (p = 0.006) were shown to influence PFS. The development of extracranial metastases was shown to influence overall survival (p = 0.029) in terms of PFS; repeat (multiple) SRS showed additional benefit.

CONCLUSIONS

SRS provides a reasonable rate of local tumor control and a low risk of adverse effects. It also leads to neurological stability or improvement in the majority of patients. Long-term close clinical and imaging follow-up is necessary due to the high probability of local recurrence and distant metastases. Repeat SRS is often effective for treating new or recurrent HPCs.

ABBREVIATIONSARE = adverse radiation effect; EBRT = external beam radiotherapy; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; HPC = hemangiopericytoma; IGKRF = International Gamma Knife Research Foundation; OS = overall survival; PFS = progression-free survival; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery; STR = subtotal resection.
Article Information

Contributor Notes

INCLUDE WHEN CITING Published online April 22, 2016; DOI: 10.3171/2016.1.JNS152860.Correspondence Or Cohen-Inbar, Department of Neurosurgery, Health Sciences Center, University of Virginia, Box 800212, Charlottesville, VA 22908. email: oc2f@virginia.edu.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Alén JFLobato RDGómez PABoto GRLagares ARamos A: Intracranial hemangiopericytoma: study of 12 cases. Acta Neurochir (Wien) 143:5755862001

  • 2

    Bassiouni HAsgari SHübschen UKönig HJStolke D: Intracranial hemangiopericytoma: treatment outcomes in a consecutive series. Zentralbl Neurochir 68:1111182007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Beadle GFHillcoat BL: Treatment of advanced malignant hemangiopericytoma with combination adriamycin and DTIC: a report of four cases. J Surg Oncol 22:1671701983

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Brunori ADelitala AOddi GChiappetta F: Recent experience in the management of meningeal hemangiopericytomas. Tumori 83:8568611997

  • 5

    Chacko GChacko AGRajshekhar VMuliyil JP: Intracranial hemangiopericytomas: correlation of topoisomerase IIalpha expression with biologic behavior. Surg Neurol 65:11172006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Chan JKCheuk WHo LCWen JM: Recurrent meningeal hemangiopericytoma with multiple metastasis and hypoglycemia: a case report. Case Rep Med 2012:6287562012

  • 7

    Chang SDSakamoto GT: The role of radiosurgery for hemangiopericytomas. Neurosurg Focus 14:5e142003

  • 8

    Coffey RJCascino TLShaw EG: Radiosurgical treatment of recurrent hemangiopericytomas of the meninges: preliminary results. J Neurosurg 78:9039081993

  • 9

    Dufour HBouillot PFigarella-Branger DNdoye NRegis JBugha TN: [Meningeal hemangiopericytomas. A retrospective reciew of 20 cases.]. Neurochirurgie 44:5181998. (Fr)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Dufour HMetellus PFuentes SMurracciole XRegis JFigarella-Branger D: Meningeal hemangiopericytoma: a retrospective study of 21 patients with special review of postoperative external radiotherapy. Neurosurgery 48:7567632001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ecker RDMarsh WRPollock BEKurtkaya-Yapicier OMcClelland RScheithauer BW: Hemangiopericytoma in the central nervous system: treatment, pathological features, and long-term follow up in 38 patients. J Neurosurg 98:118211872003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Fountas KNKapsalaki EKassam MFeltes CHDimopoulos VGRobinson JS: Management of intracranial meningeal hemangiopericytomas: outcome and experience. Neurosurg Rev 29:1451532006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Galanis EBuckner JCScheithauer BWKimmel DWSchomberg PJPiepgras DG: Management of recurrent meningeal hemangiopericytoma. Cancer 82:191519201998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Ghia AJChang ELAllen PKMahajan APenas-Prado MMcCutcheon IE: Intracranial hemangiopericytoma: patterns of failure and the role of radiation therapy. Neurosurgery 73:6246312013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Glaholm JBloom HJCrow JH: The role of radiotherapy in the management of intracranial meningiomas: the Royal Marsden Hospital experience with 186 patients. Int J Radiat Oncol Biol Phys 18:7557611990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Goellner JRLaws ERJ JrSoule EHOkazaki H: Hemangiopericytoma of the meninges. Mayo Clinic experience. Am J Clin Pathol 70:3753801978

  • 17

    Guthrie BLEbersold MJScheithauer BWShaw EG: Meningeal hemangiopericytoma: histopathological features, treatment, and long-term follow-up of 44 cases. Neurosurgery 25:5145221989

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Iwai YYamanaka K: Gamma knife radiosurgery for other primary intra-axial tumors. Prog Neurol Surg 22:1291412009

  • 19

    Jääskeläinen JServo AHaltia MWahlström TValtonen S: Intracranial hemangiopericytoma: radiology, surgery, radiotherapy, and outcome in 21 patients. Surg Neurol 23:2272361985

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Jha NMcNeese MBarkley HTJ JrKong J: Does radiotherapy have a role in hemangiopericytoma management? Report of 14 new cases and a review of the literature. Int J Radiat Oncol Biol Phys 13:139914021987

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Kano HNiranjan AKondziolka DFlickinger JCLunsford LD: Adjuvant stereotactic radiosurgery after resection of intracranial hemangiopericytomas. Int J Radiat Oncol Biol Phys 72:133313392008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Kim JWKim DGChung HTPaek SHKim YHHan JH: Gamma Knife stereotactic radiosurgery for intracranial hemangiopericytomas. J Neurooncol 99:1151222010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Kleihues PLouis DNScheithauer BWRorke LBReifenberger GBurger PC: The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:2152292002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Kumar RWani AA: Unusual tumors of the posterior fossa skull base. Skull Base 16:75842006

  • 25

    Melone AGD'Elia ASantoro FSalvati MDelfini RCantore G: Intracranial hemangiopericytoma—our experience in 30 years: a series of 43 cases and review of the literature. World Neurosurg 81:5565622014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Mena HRibas JLPezeshkpour GHCowan DNParisi JE: Hemangiopericytoma of the central nervous system: a review of 94 cases. Hum Pathol 22:84911991

  • 27

    Michishita MUto TNakazawa RYoshimura HOgihara KNaya Y: Antitumor effect of bevacizumab in a xenograft model of canine hemangiopericytoma. J Pharmacol Sci 121:3393422013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    National Cancer Institute: Common terminology criteria for adverse events v3.0 (CTCAE). 2006. (http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf) [Accessed February 26 2016]

    • PubMed
    • Export Citation
  • 29

    Olson CYen CPSchlesinger DSheehan J: Radiosurgery for intracranial hemangiopericytomas: outcomes after initial and repeat Gamma Knife surgery. J Neurosurg 112:1331392010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Park MSPatel SRLudwig JATrent JCConrad CALazar AJ: Activity of temozolomide and bevacizumab in the treatment of locally advanced, recurrent, and metastatic hemangiopericytoma and malignant solitary fibrous tumor. Cancer 117:493949472011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Payne BRPrasad DSteiner MSteiner L: Gamma surgery for hemangiopericytomas. Acta Neurochir (Wien) 142:5275372000

  • 32

    Penel NAmela EYDecanter GRobin YMMarec-Berard P: Solitary fibrous tumors and so-called hemangiopericytoma. Sarcoma 2012:6902512012

  • 33

    Peters KBMcLendon RMorse MAVredenburgh JJ: Treatment of recurrent intracranial hemangiopericytoma with SRC-related tyrosine kinase targeted therapy: a case report. Case Rep Oncol 3:93972010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Pitkethly DTHardman JMKempe LGEarle KM: Angioblastic meningiomas; clinicopathologic study of 81 cases. J Neurosurg 32:5395441970

  • 35

    Rutkowski MJJian BJBloch OChen CSughrue METihan T: Intracranial hemangiopericytoma: clinical experience and treatment considerations in a modern series of 40 adult patients. Cancer 118:162816362012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Rutkowski MJSughrue MEKane AJAranda DMills SABarani IJ: Predictors of mortality following treatment of intracranial hemangiopericytoma. J Neurosurg 113:3333392010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Schröder RFirsching RKochanek S: Hemangiopericytoma of meninges. II. General and clinical data. Zentralbl Neurochir 47:1911991986

  • 38

    Sheehan JKondziolka DFlickinger JLunsford LD: Radiosurgery for treatment of recurrent intracranial hemangiopericytomas. Neurosurgery 51:9059112002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Shinder RJackson TLAraujo DPrieto VGGuadagnolo BAEsmaeli B: Preoperative radiation therapy in the management of recurrent orbital hemangiopericytoma. Ophthal Plast Reconstr Surg 27:e126e1282011

    • Search Google Scholar
    • Export Citation
  • 40

    Snell JWSheehan JStroila MSteiner L: Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg 104:1571622006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Sonabend AMZacharia BEGoldstein HBruce SSHershman DNeugut AI: The role for adjuvant radiotherapy in the treatment of hemangiopericytoma: a Surveillance, Epidemiology, and End Results analysis. J Neurosurg 120:3003082014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Stessin AMSison CNieto JRaifu MLi B: The role of postoperative radiation therapy in the treatment of meningeal hemangiopericytoma—experience from the SEER database. Int J Radiat Oncol Biol Phys 85:7847902013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Sun SLiu AWang C: Gamma knife radiosurgery for recurrent and residual meningeal hemangiopericytomas. Stereotact Funct Neurosurg 87:1141192009

  • 44

    Suzuki HHaga YOguro KShinoda SMasuzawa TKanai N: Intracranial hemangiopericytoma with extracranial metastasis occurring after 22 years. Neurol Med Chir (Tokyo) 42:2973002002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Tashjian VSKhanlou NVinters HVCanalis RFBecker DP: Hemangiopericytoma of the cerebellopontine angle: a case report and review of the literature. Surg Neurol 72:2902952009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Tian RHao SHou ZBian LZhang YWu W: Clinical characteristics and prognostic analysis of recurrent hemangiopericytoma in the central nervous system: a review of 46 cases. J Neurooncol 115:53592013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Uemura SKuratsu JHamada JYoshioka SKochi MUshio Y: Effect of radiation therapy against intracranial hemangiopericytoma. Neurol Med Chir (Tokyo) 32:3283321992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    Veeravagu AJiang BPatil CGLee MSoltys SGGibbs IC: CyberKnife stereotactic radiosurgery for recurrent, metastatic, and residual hemangiopericytomas. J Hematol Oncol 6:262011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49

    Vuorinen VSallinen PHaapasalo HVisakorpi TKallio MJääskeläinen J: Outcome of 31 intracranial haemangiopericytomas: poor predictive value of cell proliferation indices. Acta Neurochir (Wien) 138:139914081996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 461 461 122
Full Text Views 582 404 1
PDF Downloads 261 173 3
EPUB Downloads 0 0 0
PubMed
Google Scholar