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Neurosurgery:
doi: 10.1227/NEU.0000000000000064
Research-Human-Clinical Studies

Intracranial Hemangiopericytoma: Patterns of Failure and the Role of Radiation Therapy

Ghia, Amol J. MD*; Chang, Eric L. MD; Allen, Pamela K. PhD*; Mahajan, Anita MD*; Penas-Prado, Marta MD§; McCutcheon, Ian E. MD; Brown, Paul D. MD*

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Abstract

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 dose

CSS, cause-specific survival

HPC, hemangiopericytomas

LC, local control

MFS, metastasis-free survival

M-HPC, meningeal hemangiopericytoma

MVA, multivariate analysis

OS, overall survival

PORT, postoperative radiotherapy

RFS, recurrence-free survival

RT, radiotherapy

STR, subtotal resection

Copyright © by the Congress of Neurological Surgeons

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