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Postoperative stereotactic radiosurgery for intracranial solitary fibrous tumors: systematic review and pooled quantitative analysis

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Abstract

Background

Intracranial solitary fibrous tumors (SFTs), formerly hemangiopericytomas (HPCs), are rare, aggressive dural-based mesenchymal tumors. While adjuvant radiation therapy has been suggested to improve local tumor control (LTC), especially after subtotal resection, the role of postoperative stereotactic radiosurgery (SRS) and the optimal SRS dosing strategy remain poorly defined.

Methods

PubMed, EMBASE, and Web of Science were systematically searched according to PRISMA guidelines for studies describing postoperative SRS for intracranial SFTs. The search strategy was defined in the authors’ PROSPERO protocol (CRD42023454258).

Results

15 studies were included describing 293 patients harboring 476 intracranial residual or recurrent SFTs treated with postoperative SRS. At a mean follow-up of 21–77 months, LTC rate after SRS was 46.4–93% with a mean margin SRS dose of 13.5–21.7 Gy, mean maximum dose of 27-39.6 Gy, and mean isodose at the 42.5–77% line. In pooled analysis of individual tumor outcomes, 18.7% of SFTs demonstrated a complete SRS response, 31.7% had a partial response, 18.9% remained stable (overall LTC rate of 69.3%), and 30.7% progressed. When studies were stratified by margin dose, a mean margin dose > 15 Gy showed an improvement in LTC rate (74.7% versus 65.7%).

Conclusions

SRS is a safe and effective treatment for intracranial SFTs. In the setting of measurable disease, our pooled data suggests a potential dose response of improving LTC with increasing SRS margin dose. Our improved understanding of the aggressive biology of SFTs and the tolerated adjuvant SRS parameters supports potentially earlier use of SRS in the postoperative treatment paradigm for intracranial SFTs.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Neurosurgery, Northwell Health, Manhasset, NY, USA

    Danielle Golub, Prashin Unadkat, Timothy G. White, Michael Schulder & Amir R. Dehdashti

  2. Zucker School of Medicine, Hofstra University/Northwell Health, Hempstead, NY, USA

    Joshua D. McBriar

  3. Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Hayley Donaldson

  4. SUNY Downstate College of Medicine, Brooklyn, NY, USA

    Taylor Wong

  5. Department of Neurosurgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA

    Eric T. Quach

  6. Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA

    Sara Haddock

  7. Department of Radiation Oncology, Northwell Health, Manhasset, NY, USA

    Bhargava Chitti & Anuj Goenka

  8. Department of Pathology, Northwell Health, Manhasset, NY, USA

    Yonah Ziemba

  9. Department of Neurology, Northwell Health, New Hyde Park, NY, USA

    Samuel Singer

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Contributions

Manuscript drafting (DG, JDB, HD, TW, PU); Figure and table design (DG, TW, PU, TGW, BC, MS, ARD); Manuscript editing and revision (DG, JDB, HD, TW, ETQ, BC, YZ, AG, SS, MS, ARD); Literature review (DG, JDB, HD, TW, TGW, ETQ, BC); Data Analysis (DG, JDB, HD, PU, TGW, ETQ, BC); Research team management and oversight (DG, ETQ, YZ, AG, SS, MS, ARD).

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Correspondence to Danielle Golub.

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Golub, D., McBriar, J.D., Donaldson, H. et al. Postoperative stereotactic radiosurgery for intracranial solitary fibrous tumors: systematic review and pooled quantitative analysis. J Neurooncol 165, 229–239 (2023). https://doi.org/10.1007/s11060-023-04499-w

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