The role for adjuvant radiotherapy in the treatment of hemangiopericytoma: A surveillance, epidemiology, and end results analysis

Adam M. Sonabend, Brad Zacharia, Hannah Goldstein, Samuel S. Bruce, Dawn Hershman, Alfred I. Neugut, Jeffrey N. Bruce

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Object. Central nervous system (CNS) hemangiopericytomas are relatively uncommon and unique among CNS tumors as they can originate from or develop metastases outside of the CNS. Significant difference of opinion exists in the management of these lesions, as current treatment paradigms are based on limited clinical experience and single-institution series. Given these limitations and the absence of prospective clinical trials within the literature, nationwide registries have the potential to provide unique insight into the efficacy of various therapies. Methods. The authors queried the Surveillance Epidemiology and End Results (SEER) database to investigate the clinical behavior and prognostic factors for hemangiopericytomas originating within the CNS during the years 2000-2009. The SEER survival data were adjusted for demographic factors including age, sex, and race. Univariate and multivariate analyses were performed to identify characteristics associated with overall survival. Results. The authors identified 227 patients with a diagnosis of CNS hemangiopericytoma. The median length of follow-up was 34 months (interquartile range 11-63 months). Median survival was not reached, but the 5-year survival rate was 83%. Univariate analysis showed that age and radiation therapy were significantly associated with survival. Moreover, young age and supratentorial location were significantly associated with survival on multivariate analysis. Most importantly, multivariate analysis using the Cox proportional hazards model showed a statistically significant survival benefit for patients treated with gross-total resection (GTR) in combination with adjuvant radiation treatment (HR 0.31 [95% CI 0.01-0.95], p = 0.04), an effect not appreciated with GTR alone. Conclusions. The authors describe the epidemiology of CNS hemangiopericytomas in a large, national cancer database, evaluating the effectiveness of various treatment paradigms used in clinical practice. In this study, an over-all survival benefit was found when GTR was accomplished and combined with radiation therapy. This finding has not been appreciated in previous series of patients with CNS hemangiopericytoma and warrants future investigations into the role of upfront adjuvant radiation therapy.

Original languageEnglish (US)
Pages (from-to)300-308
Number of pages9
JournalJournal of Neurosurgery
Volume120
Issue number2
DOIs
StatePublished - Feb 1 2014

Fingerprint

Hemangiopericytoma
Adjuvant Radiotherapy
Epidemiology
Central Nervous System
Survival
Radiotherapy
Multivariate Analysis
Therapeutics
Databases
Central Nervous System Neoplasms
Proportional Hazards Models
Registries
Survival Rate
Demography
Clinical Trials
Radiation
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Sonabend, Adam M. ; Zacharia, Brad ; Goldstein, Hannah ; Bruce, Samuel S. ; Hershman, Dawn ; Neugut, Alfred I. ; Bruce, Jeffrey N. / The role for adjuvant radiotherapy in the treatment of hemangiopericytoma : A surveillance, epidemiology, and end results analysis. In: Journal of Neurosurgery. 2014 ; Vol. 120, No. 2. pp. 300-308.
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title = "The role for adjuvant radiotherapy in the treatment of hemangiopericytoma: A surveillance, epidemiology, and end results analysis",
abstract = "Object. Central nervous system (CNS) hemangiopericytomas are relatively uncommon and unique among CNS tumors as they can originate from or develop metastases outside of the CNS. Significant difference of opinion exists in the management of these lesions, as current treatment paradigms are based on limited clinical experience and single-institution series. Given these limitations and the absence of prospective clinical trials within the literature, nationwide registries have the potential to provide unique insight into the efficacy of various therapies. Methods. The authors queried the Surveillance Epidemiology and End Results (SEER) database to investigate the clinical behavior and prognostic factors for hemangiopericytomas originating within the CNS during the years 2000-2009. The SEER survival data were adjusted for demographic factors including age, sex, and race. Univariate and multivariate analyses were performed to identify characteristics associated with overall survival. Results. The authors identified 227 patients with a diagnosis of CNS hemangiopericytoma. The median length of follow-up was 34 months (interquartile range 11-63 months). Median survival was not reached, but the 5-year survival rate was 83{\%}. Univariate analysis showed that age and radiation therapy were significantly associated with survival. Moreover, young age and supratentorial location were significantly associated with survival on multivariate analysis. Most importantly, multivariate analysis using the Cox proportional hazards model showed a statistically significant survival benefit for patients treated with gross-total resection (GTR) in combination with adjuvant radiation treatment (HR 0.31 [95{\%} CI 0.01-0.95], p = 0.04), an effect not appreciated with GTR alone. Conclusions. The authors describe the epidemiology of CNS hemangiopericytomas in a large, national cancer database, evaluating the effectiveness of various treatment paradigms used in clinical practice. In this study, an over-all survival benefit was found when GTR was accomplished and combined with radiation therapy. This finding has not been appreciated in previous series of patients with CNS hemangiopericytoma and warrants future investigations into the role of upfront adjuvant radiation therapy.",
author = "Sonabend, {Adam M.} and Brad Zacharia and Hannah Goldstein and Bruce, {Samuel S.} and Dawn Hershman and Neugut, {Alfred I.} and Bruce, {Jeffrey N.}",
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The role for adjuvant radiotherapy in the treatment of hemangiopericytoma : A surveillance, epidemiology, and end results analysis. / Sonabend, Adam M.; Zacharia, Brad; Goldstein, Hannah; Bruce, Samuel S.; Hershman, Dawn; Neugut, Alfred I.; Bruce, Jeffrey N.

In: Journal of Neurosurgery, Vol. 120, No. 2, 01.02.2014, p. 300-308.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The role for adjuvant radiotherapy in the treatment of hemangiopericytoma

T2 - A surveillance, epidemiology, and end results analysis

AU - Sonabend, Adam M.

AU - Zacharia, Brad

AU - Goldstein, Hannah

AU - Bruce, Samuel S.

AU - Hershman, Dawn

AU - Neugut, Alfred I.

AU - Bruce, Jeffrey N.

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Object. Central nervous system (CNS) hemangiopericytomas are relatively uncommon and unique among CNS tumors as they can originate from or develop metastases outside of the CNS. Significant difference of opinion exists in the management of these lesions, as current treatment paradigms are based on limited clinical experience and single-institution series. Given these limitations and the absence of prospective clinical trials within the literature, nationwide registries have the potential to provide unique insight into the efficacy of various therapies. Methods. The authors queried the Surveillance Epidemiology and End Results (SEER) database to investigate the clinical behavior and prognostic factors for hemangiopericytomas originating within the CNS during the years 2000-2009. The SEER survival data were adjusted for demographic factors including age, sex, and race. Univariate and multivariate analyses were performed to identify characteristics associated with overall survival. Results. The authors identified 227 patients with a diagnosis of CNS hemangiopericytoma. The median length of follow-up was 34 months (interquartile range 11-63 months). Median survival was not reached, but the 5-year survival rate was 83%. Univariate analysis showed that age and radiation therapy were significantly associated with survival. Moreover, young age and supratentorial location were significantly associated with survival on multivariate analysis. Most importantly, multivariate analysis using the Cox proportional hazards model showed a statistically significant survival benefit for patients treated with gross-total resection (GTR) in combination with adjuvant radiation treatment (HR 0.31 [95% CI 0.01-0.95], p = 0.04), an effect not appreciated with GTR alone. Conclusions. The authors describe the epidemiology of CNS hemangiopericytomas in a large, national cancer database, evaluating the effectiveness of various treatment paradigms used in clinical practice. In this study, an over-all survival benefit was found when GTR was accomplished and combined with radiation therapy. This finding has not been appreciated in previous series of patients with CNS hemangiopericytoma and warrants future investigations into the role of upfront adjuvant radiation therapy.

AB - Object. Central nervous system (CNS) hemangiopericytomas are relatively uncommon and unique among CNS tumors as they can originate from or develop metastases outside of the CNS. Significant difference of opinion exists in the management of these lesions, as current treatment paradigms are based on limited clinical experience and single-institution series. Given these limitations and the absence of prospective clinical trials within the literature, nationwide registries have the potential to provide unique insight into the efficacy of various therapies. Methods. The authors queried the Surveillance Epidemiology and End Results (SEER) database to investigate the clinical behavior and prognostic factors for hemangiopericytomas originating within the CNS during the years 2000-2009. The SEER survival data were adjusted for demographic factors including age, sex, and race. Univariate and multivariate analyses were performed to identify characteristics associated with overall survival. Results. The authors identified 227 patients with a diagnosis of CNS hemangiopericytoma. The median length of follow-up was 34 months (interquartile range 11-63 months). Median survival was not reached, but the 5-year survival rate was 83%. Univariate analysis showed that age and radiation therapy were significantly associated with survival. Moreover, young age and supratentorial location were significantly associated with survival on multivariate analysis. Most importantly, multivariate analysis using the Cox proportional hazards model showed a statistically significant survival benefit for patients treated with gross-total resection (GTR) in combination with adjuvant radiation treatment (HR 0.31 [95% CI 0.01-0.95], p = 0.04), an effect not appreciated with GTR alone. Conclusions. The authors describe the epidemiology of CNS hemangiopericytomas in a large, national cancer database, evaluating the effectiveness of various treatment paradigms used in clinical practice. In this study, an over-all survival benefit was found when GTR was accomplished and combined with radiation therapy. This finding has not been appreciated in previous series of patients with CNS hemangiopericytoma and warrants future investigations into the role of upfront adjuvant radiation therapy.

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