Gamma Knife Radiosurgery For Intracranial Hemangiopericytoma

Keywords: gamma knife, radiosurgery, hemangiopericytoma, outcome, brain tumor

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     Hemangiopericytoma (HP) is a locally aggressive, potentially malignant tumor, which frequently causes distant metastases. There remains a controversy about the best way to manage HP, and little information exists concerning the role of Gamma Knife radiosurgery (GKRS).
     Here we examined the role of GKRS for the management of intracranial HP.
     Between July 1998 and October 2009, 2871 patients were treated. Of them, 11 patients (0.38%) with histologically confirmed intracranial HP were included in this study. Ten tumors were primary intracranial HP and 1 was a metastasis from the lower limb. Seven were males and 4 were females.
     The patients were treated by GKRS.
     Their mean age at the diagnosis and at GKRS was 48 years-old and 54 years-old, respectively. The mean interval between the diagnosis and GKRS was 68 months, ranging from 0 to 237 months. The mean volume of the tumor was 9.0 mL, ranging from 1.9 to 29.9 mL. The mean dosage delivered onto the tumor periphery was 20 Gy, ranging from 15 to 22 Gy. After a mean follow-up of 44 month, ranging from 4 to 109 months, 6 patients were alive and 5 have died. The cause of death in 5 patients was the progression of the tumor in distant metastatic sites. The intracranial tumor was controllable even though repetitive GKRSs were necessary in 3 cases (27%). Local recurrence was observed 7-25 months (mean 17 months) after GKRS. Distant metastases were observed in 7 cases, and the interval was 0-57 (mean 22) months after GKRS and 17-240 (mean 108) months after the diagnosis, respectively. Median survival and distant metastases free survival after GKRS was 77 months and 52 months, respectively by Kaplan-Meier analysis. Local recurrence did not affect the survival period (p=0.89). All patients without distant metastases were alive for 8-109 (mean 44) months after GKRS (p=0.08).
     This is a retrospective study.
     GKRS is efficacious in controlling intracranial HP locally.
     Distant metastasis is the most critical factor for survival and meticulous follow up is mandatory to avoid a delay in treating metastatic tumor.


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