title: The role of postoperative radiation therapy in the treatment of meningeal hemangiopericytoma-experience from the SEER database.
abstract: OBJECTIVE
  The aim of this study was to examine the effect of postoperative radiation therapy (RT) on cause-specific survival in patients with meningeal hemangiopericytomas.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database from 1990-2008 was queried for cases of surgically resected central nervous system hemangiopericytoma. Patient demographics, tumor location, and extent of resection were included in the analysis as covariates. The Kaplan-Meier product-limit method was used to analyze cause-specific survival. A Cox proportional hazards regression analysis was conducted to determine which factors were associated with cause-specific survival.
  
  
  RESULTS
  The mean follow-up time is 7.9 years (95 months). There were 76 patients included in the analysis, of these, 38 (50%) underwent gross total resection (GTR), whereas the other half underwent subtotal resection (STR). Postoperative RT was administered to 42% (16/38) of the patients in the GTR group and 50% (19/38) in the STR group. The 1-year, 10-year, and 20-year cause-specific survival rates were 99%, 75%, and 43%, respectively. On multivariate analysis, postoperative RT was associated with significantly better survival (HR = 0.269, 95% CI 0.084-0.862; P=.027), in particular for patients who underwent STR (HR = 0.088, 95% CI: 0.015-0.528; P<.008).
  
  
  CONCLUSIONS
  In the absence of large prospective trials, the current clinical decision-making of hemangiopericytoma is mostly based on retrospective data. We recommend that postoperative RT be considered after subtotal resection for patients who could tolerate it. Based on the current literature, the practical approach is to deliver limited field RT to doses of 50-60 Gy while respecting the normal tissue tolerance. Further investigations are clearly needed to determine the optimal therapeutic strategy.
authors.affiliation: Department of Radiation Oncology, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Stessin
authors.forename: Cristina
authors.initials: C
authors.lastname: Sison
authors.forename: Jaime
authors.initials: J
authors.lastname: Nieto
authors.forename: Muri
authors.initials: M
authors.lastname: Raifu
authors.forename: Baoqing
authors.initials: B
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006393:Hemangiopericytoma / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods / Q000401:mortality; D011879:Radiotherapy Dosage; D035583:Rare Diseases / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D012044:Regression Analysis; D018426:SEER Program; D015996:Survival Rate; D055815:Young Adult