====== Intracranial Solitary Fibrous Tumor Treatment ======

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The management of **[[intracranial solitary fibrous tumor]]s (SFTs)** is based on histological grade, resection extent, and recurrence risk. Due to their potential for recurrence and metastasis, even many years after diagnosis, long-term follow-up and multimodal treatment are often warranted.

==== Primary Treatment ====
  * **Gross Total Resection (GTR)**:
    * Mainstay of treatment for all WHO grades.
    * Achieving GTR significantly improves **local control** and **progression-free survival** (PFS).
    * Intraoperative navigation and careful dural dissection may assist in achieving clear margins.

==== Postoperative Radiotherapy (PORT) ====
  * **Indicated in the following scenarios**:
    * WHO **Grade II or III** tumors
    * **Subtotal resection (STR)**
    * Recurrent disease
  * Improves **local control**, especially in high-grade or incompletely resected tumors.
  * Techniques:
    * **External Beam Radiotherapy (EBRT)**
    * **Stereotactic Radiotherapy (SRT)** for focal or residual disease
    * Dose range: 50–60 Gy in conventional fractionation

==== Role of Chemotherapy ====
  * Generally **limited** due to lack of robust evidence.
  * May be considered in:
    * **High-grade, metastatic, or unresectable tumors**
    * **Recurrent disease** after surgery and radiotherapy
  * Agents used (off-label): temozolomide, bevacizumab, or anthracycline-based regimens

==== Recurrence and Metastasis ====
  * Even **Grade I SFTs** can recur locally.
  * Grades II–III are associated with:
    * Higher recurrence rates
    * Distant metastases (e.g., lung, liver, bone)
  * **Surveillance imaging** (MRI) is recommended:
    * Every 6 months for the first 2–3 years
    * Annually thereafter for long-term follow-up

==== Summary Table ====
^ Treatment Modality ^ Indication ^ Notes ^
| Gross Total Resection | All grades | Aim for complete resection with clear margins |
| Postoperative Radiotherapy | Grade II–III, STR, recurrence | Improves local control |
| Chemotherapy | Refractory, metastatic cases | Limited evidence; palliative role |
| Surveillance Imaging | All patients | Lifelong follow-up due to delayed recurrence/metastasis |


===== Systematic review and meta‑analysis =====

In a [[systematic review]] and [[metaanalysis]]  
Na et al.  
from the Hanyang University, Seoul; Kangnam Sacred Heart Hospital, Seoul; Chung‑Ang University, Seoul & Gwangmyeong; Dongsan Medical Center, Daegu  
published in the Journal [[Scientific Reports]] (Nature)  
to determine whether postoperative radiotherapy (PORT) after [[gross total resection]] (GTR) of intracranial [[solitary fibrous tumor]]s (SFT) improves [[Progression-Free Survival]] (PFS), [[overall survival]] (OS), and [[metastasis‑free survival]] (MFS).  
PORT significantly improved both PFS and OS after GTR; no effect on MFS. [[Author]]s suggest PORT should be considered for all intracranial SFT patients post‑GTR
((Na MK, Choi KS, Lim TH, Shin H, Lee J, Lee H, Kim W, Kim JG, Cho Y, Ahn C, Kim JH, Jang BH, Namgung M, Kwon SM. A [[systematic review]] and [[meta-analysis]] on the [[efficacy]] of [[postoperative radiotherapy]] after [[gross total resection]] of [[intracranial solitary fibrous tumor]]s. Sci Rep. 2025 Jul 2;15(1):23368. doi: 10.1038/s41598-025-02170-0. PMID: 40603922.)).

=== Critical appraisal ===

* **Scope & relevance** – Addresses a clinically important and under‑consensus management question: role of radiotherapy after resection of rare intracranial SFT.  

* **Methodology** – Follows PRISMA guidelines; searched Medline, Embase, Cochrane. Included 12 studies totalling 419 patients. Meta‑analysis of hazard ratios for survival. However, heterogeneity among included studies—some retrospective, variable PORT protocols (dose, timing), inconsistent follow‑up durations.  

* **Statistical strength** – Pooled HRs show clear benefit in PFS and OS. Subgroup analysis for grades 2–3 supports findings. Yet, no mention of publication‑bias assessments (e.g., funnel‑plot or Egger’s test) or sensitivity analyses excluding poor‑quality studies.  

* **Limitations** – Lack of detailed quality scoring for individual studies; variation in grading systems over time (hemangiopericytoma terminology overlap); absence of toxicity or quality‑of‑life data post‑PORT; no randomized controlled trials included.  

* **Clinical impact** – Suggests consistent survival advantage favoring PORT, but generalizability is limited by retrospective data and tumor rarity.

=== Final Verdict ===  

While methodologically sound and compelling in its aggregate survival benefit findings, the [[evidence]] remains moderate due to heterogeneity and [[retrospective]] design. More robust [[prospective]] data are needed, but in high‑grade or borderline cases, PORT can be strongly considered.

**Rating**:: 7.5 / 10  

=== Takeaway for practicing neurosurgeon ===  

After [[gross total resection]] of [[intracranial solitary fibrous tumor]]s—especially [[WHO]] grade 2 or 3—[[adjuvant]] [[radiotherapy]] appears to provide meaningful improvements in both progression‑free and [[overall survival]]. Given the [[retrospective]] evidence, surgeons and neuro‑oncologists should include PORT in multidisciplinary [[discussion]]s and patient [[counseling]].

**Bottom line**:: In the absence of randomized [[evidence]], PORT is a reasonable addition to surgery for intracranial SFT to extend [[survival]].

**Corresponding author’s email**:: [[kwonsaemin@hanmail.net]]