Intracranial Solitary Fibrous Tumor Treatment
The management of intracranial solitary fibrous tumors (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 tumors (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. Authors suggest PORT should be considered for all intracranial SFT patients post‑GTR 1).
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 tumors—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 discussions 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