Abstract：
BACKGROUND: Intracranial solitary fibrous tumors (SFTs), formerly hemangiopericytomas (HPCs), are rare, aggressive dural-based mesenchymal tumors. While adjuvant radiation therapy has been suggested to improve local tumor control (LTC), especially after subtotal resection, the role of postoperative stereotactic radiosurgery (SRS) and the optimal SRS dosing strategy remain poorly defined.
METHODS: PubMed, EMBASE, and Web of Science were systematically searched according to PRISMA guidelines for studies describing postoperative SRS for intracranial SFTs. The search strategy was defined in the authors\' PROSPERO protocol (CRD42023454258).
RESULTS: 15 studies were included describing 293 patients harboring 476 intracranial residual or recurrent SFTs treated with postoperative SRS. At a mean follow-up of 21-77 months, LTC rate after SRS was 46.4-93% with a mean margin SRS dose of 13.5-21.7 Gy, mean maximum dose of 27-39.6 Gy, and mean isodose at the 42.5-77% line. In pooled analysis of individual tumor outcomes, 18.7% of SFTs demonstrated a complete SRS response, 31.7% had a partial response, 18.9% remained stable (overall LTC rate of 69.3%), and 30.7% progressed. When studies were stratified by margin dose, a mean margin dose > 15 Gy showed an improvement in LTC rate (74.7% versus 65.7%).
CONCLUSIONS: SRS is a safe and effective treatment for intracranial SFTs. In the setting of measurable disease, our pooled data suggests a potential dose response of improving LTC with increasing SRS margin dose. Our improved understanding of the aggressive biology of SFTs and the tolerated adjuvant SRS parameters supports potentially earlier use of SRS in the postoperative treatment paradigm for intracranial SFTs.
METHODS: PubMed, EMBASE, and Web of Science were systematically searched according to PRISMA guidelines for studies describing postoperative SRS for intracranial SFTs. The search strategy was defined in the authors\' PROSPERO protocol (CRD42023454258).
RESULTS: 15 studies were included describing 293 patients harboring 476 intracranial residual or recurrent SFTs treated with postoperative SRS. At a mean follow-up of 21-77 months, LTC rate after SRS was 46.4-93% with a mean margin SRS dose of 13.5-21.7 Gy, mean maximum dose of 27-39.6 Gy, and mean isodose at the 42.5-77% line. In pooled analysis of individual tumor outcomes, 18.7% of SFTs demonstrated a complete SRS response, 31.7% had a partial response, 18.9% remained stable (overall LTC rate of 69.3%), and 30.7% progressed. When studies were stratified by margin dose, a mean margin dose > 15 Gy showed an improvement in LTC rate (74.7% versus 65.7%).
CONCLUSIONS: SRS is a safe and effective treatment for intracranial SFTs. In the setting of measurable disease, our pooled data suggests a potential dose response of improving LTC with increasing SRS margin dose. Our improved understanding of the aggressive biology of SFTs and the tolerated adjuvant SRS parameters supports potentially earlier use of SRS in the postoperative treatment paradigm for intracranial SFTs.
摘要：
背景：颅内孤立性纤维瘤（SFT），以前的血管外皮细胞瘤（HPCs），是罕见的，侵袭性硬脑膜间质瘤。虽然辅助放射治疗已被建议改善局部肿瘤控制（LTC），尤其是在次全切除后，术后立体定向放射外科(SRS)的作用和最佳SRS给药策略仍不明确.
方法：PubMed，EMBASE,根据PRISMA指南对描述颅内SFT术后SRS的研究进行了系统搜索和WebofScience。搜索策略在作者的PROSPERO方案(CRD42023454258)中定义。
结果：纳入15项研究，描述293例患者有476例颅内残留或复发的SFT接受术后SRS治疗。平均随访21-77个月,SRS后的LTC率为46.4-93％，平均SRS剂量为13.5-21.7Gy，平均最大剂量为27-39.6Gy，和平均等剂量在42.5-77%线。在单个肿瘤结果的汇总分析中，18.7%的SFT表现出完整的SRS响应，31.7%有部分反应，18.9%保持稳定(整体LTC率为69.3%),进步了30.7%。当研究按边缘剂量分层时，平均边缘剂量>15Gy显示LTC率改善(74.7%对65.7%)。
结论：SRS是颅内SFT安全有效的治疗方法。在可测量的疾病背景下，我们汇总的数据提示,随着SRS边缘剂量的增加,LTC有改善的潜在剂量反应.我们对SFT的侵袭性生物学和耐受的辅助SRS参数的更好理解支持在颅内SFT的术后治疗范例中可能更早地使用SRS。
方法：PubMed，EMBASE,根据PRISMA指南对描述颅内SFT术后SRS的研究进行了系统搜索和WebofScience。搜索策略在作者的PROSPERO方案(CRD42023454258)中定义。
结果：纳入15项研究，描述293例患者有476例颅内残留或复发的SFT接受术后SRS治疗。平均随访21-77个月,SRS后的LTC率为46.4-93％，平均SRS剂量为13.5-21.7Gy，平均最大剂量为27-39.6Gy，和平均等剂量在42.5-77%线。在单个肿瘤结果的汇总分析中，18.7%的SFT表现出完整的SRS响应，31.7%有部分反应，18.9%保持稳定(整体LTC率为69.3%),进步了30.7%。当研究按边缘剂量分层时，平均边缘剂量>15Gy显示LTC率改善(74.7%对65.7%)。
结论：SRS是颅内SFT安全有效的治疗方法。在可测量的疾病背景下，我们汇总的数据提示,随着SRS边缘剂量的增加,LTC有改善的潜在剂量反应.我们对SFT的侵袭性生物学和耐受的辅助SRS参数的更好理解支持在颅内SFT的术后治疗范例中可能更早地使用SRS。
