adjuvant RT for Anaplastic Hemangiopericytoma?

[Kroll2013]

Dear colleagues,

I need your opinion concerning this patient:
23 years old well fit patient, that presented with left hemifacial paresthesia and upper left limb weakness.
Brain MRI showed 8.7*6.6*5 cm right fronto-parietal lesion, multi-lobulated with cystic components, with an irregular appearance of the overlying bone with very probable infiltration of the diploic space.
craniotomy was done. pathology showed an anaplastic hemangiopericytoma.
his symptoms resolved after the surgery.

4 months later, his symptoms recurred focally at the level of the upper limb.
MRI showed a recurrent nodular lesion within the previous tumor bed.

his was referred for radiation.

what dose/ volume do you suggest ?

- FSRT (5 fractions ) versus 54-60 Gy /2Gy per fraction
- CTV= cavity + enhancig lesion + 1cm versus enhancing nodule only ?

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[seper]

One and only patient I've treated got 60 Gy with generous margins. I'm not sure what is the standard of care here. If you're considering SRT, perhaps it's worth pushing dose higher.

 

[Neuronix]

Is it resectable? I treat these much like high grade meningiomas--maximum safe surgical resection followed by adjuvant RT to the tumor bed.

I'd do 60 Gy / 30 fx to the gross, initial resection tumor bed, and 1 cm margin. I'd trim the 1 cm off normal brain assuming there was no brain invasion.

 

[evilbooyaa]

I have not treated and in general don't know enough about hemangiopericytoma specifically to make any specific recommendations, but in general, things in the brain that are 'anaplastic' or synonymous do not get stereotactic RT, but more comprehensive coverage, in the radiation-naive patient. This holds for glioma, meningioma, ependymoma, etc.

 

[RadOncMegatron]

Is it resectable? I treat these much like high grade meningiomas--maximum safe surgical resection followed by adjuvant RT to the tumor bed.

I'd do 60 Gy / 30 fx to the gross, initial resection tumor bed, and 1 cm margin. I'd trim the 1 cm off normal brain assuming there was no brain invasion.

I completely agree here. I don't think SRT will improve anything besides convenience.

 

[Cancerdancer]

23 yo?
Get them to a real NSG (one who knows this should've been referred to rad onc the first time) and who can get this out again.
Then 60 Gy with standard fractionation.
This is not a case to play nice with your local referring NSG with. They messed this up the first time around. If they are balking at 2nd resection, make them refer elsewhere or facilitate yourself.