Repeated Stereotactic Radiosurgery For Multiple Hemangiopericytomas: Report Of Two Cases

Masao Tago1, Tomoyuki Koga2, Masahiro Shin2, Atsuro Terahara2, Keiichi Nakagawa2, Kuni Ohtomo2, Nobuhito Saito2

1Toho University Omori Medical Center 2University of Tokyo Hospital

Keywords: hemangiopericytoma, radiosurgery, gamma knife, recurrent disease, outcome

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     The treatment of multiple hemangiopericytomas that repeatedly recur still remains a therapeutic challenge even with the state-of-the-art treatment modalities. 
     We present two cases of multiple hemangiopericytomas who were successfully treated with repeated gamma knife radiosurgery.
     Case 1: A 47-year-old female patient initially presented with right parasagittal tumor, and underwent surgery. Case 2: A 54-year-old female patient had a surgical resection for left cerebellar tentorial tumor.
     Case 1:Thereafter, she underwent additional four times of surgical resections for recurrent tumors. However, magnetic resonance imaging obtained a year after the last surgery disclosed 7 lesions that either recurred or newly developed. Gamma knife radiosurgery was applied to them. Case 2: Another surgery was undergone six years later because of the local recurrence. The tumor regrew again and was applied to gamma knife radiosurgery.
     Case 1: Totally 16 new tumors that developed thereafter and 7 tumors that showed regrowth were treated yearly with nine sessions of radiosurgery. After precisely targeted irradiation more than 18 Gy to the tumors using gamma knife, growth of all tumors but two were controlled. She underwent two neurosurgical resections for the increasing tumors nine years after the last surgery before radiosurgical treatments. Normal higher cortical function was preserved. However she had multiple metastases in the lungs, liver, and right kidney. Case 2: The recurrent tumor was irradiated 18 Gy to the margin. Additional seven radiosurgical treatments were undergone for 9 new tumors and 9 recurrent ones with the marginal dose of 15 Gy or more in the next ten years. Her neurological function has not deteriorated since the initial radiosurgery.
     This is a retrospective study.
     Repeated gamma knife radiosurgery may be an effective treatment option for multiple hemangiopericytomas from the viewpoint of prolongation of the interval between surgical interventions and preserving brain functions.
     It can prolong the interval between surgical interventions and preserving brain functions.


Project Roles:

M. Tago (), T. Koga (), M. Shin (), A. Terahara (), K. Nakagawa (), K. Ohtomo (), N. Saito ()