Impact of adjuvant therapy on survival in treatment of CNS hemangiopericytomas.
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INTRODUCTION: Central nervous system (CNS) Hemangiopericytoma is a rare tumor which account for <0.5% of all CNS tumors. The purpose of this study was to assess the clinical outcomes and the impact of adjuvant treatment on survival. MATERIALS/ METHODS: A total of 64 patients histo-pathologically diagnosed as CNS Hemangiopericytoma, treated between 2000 and 2018 with or without adjuvant radiation and chemotherapy, were evaluated for the various survival parameters. Kaplan Meier method was utilized for assessment of the survival outcomes. Treatment and demographic parameters were assessed as prognostic factors for the survival outcomes using Multivariate analysis. The patients were followed up as per the institution protocol. RESULTS: The median follow-up was 50.6 months (range: 8-158 months). The median age was 40 years (range: 8-63 years), with 44 male and 20 female patients. Headache was the most common symptom (46 patients, 71.8%), followed by visual disturbances (18 patients, 28.1%). Tumors were primarily supratentorial (50 patients, 78.1%), with a median diameter of 5 cm (range: 2-7.6 cm). Gross total resection (GTR) was achieved in 40 patients (62.5%). Of the cohort, 34 patients (53.1%) had WHO grade II tumors, and 30 (46.9%) had grade III tumors. Radiation therapy was administered to 54 patients (84.4%) with a median dose of 60 Gy (range: 40-60 Gy), and 8 patients (12.5%) received stereotactic radiation therapy (median: 16.1 Gy). Adjuvant chemotherapy (ifosfamide and epirubicin-based) was given to 40 patients (62.5%). Recurrence occurred in 31 patients (48.4%), with 24 patients (37.5%) experiencing local recurrence and 7 patients (10.9%) developing distant metastases. The median recurrence-free survival (RFS) was 38.4 months, and the median overall survival (OS) was 44 months. Multivariate analysis showed that radiation therapy (p = 0.012), chemotherapy (p < 0.001), and GTR (p = 0.023) significantly reduced recurrence risk. CONCLUSION: Even though CNS Hemangiopericytoma is a rare disease entity, local and distant recurrences are a cause of concern and require evaluation of role of adjuvant therapy. Our study shows that complete excision followed by adjuvant therapy in the form of radiation therapy and chemotherapy improves the survival in CNS Hemangiopericytoma. Besides the prognostic factors assessed, there is a need for larger prospective study to improve the treatment outcomes.