Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro Patterns of care and outcomes of postoperative radiation for intracranial hemangiopericytoma in United States hospitals Anna Lee a,b, ⁎ , Baho Sidiqi a , Arthur Wang c , Joseph Safdieh a,d , David Schreiber a,e a Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States b Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, United States c Department of Neurosurgery, New York Medical College/Westchester Medical Center, Valhalla, NY, United States d Kings County Hospital Center, Brooklyn, NY, United States e Summit Medical Group of MD Anderson Cancer Center, Berkeley Heights, NJ, United States ARTICLE INFO Keywords: Intracranial hemangiopericytoma Postoperative radiation NCDB ABSTRACT Objective: Several small (< 100 patients) studies have been suggestive of a survival benefit associated with postoperative radiation for intracranial hemangiopericytoma. Given the rarity of this disease, we sought to examine the patterns of care and outcomes of this tumor in the National Cancer Database (NCDB). Patients and Methods: We accessed the NCDB to identify patients with intracranial hemangiopericytoma between 2004–2012. Patients were categorized by surgical status, postoperative radiation usage, and location (meningeal or brain parenchyma). Multivariable Cox regression was used to identify covariables associated with differences in survival. Results: There were 588 patients included in this study, of which 323 (54.9%) received postoperative radiation. The median age at diagnosis was 51 years and the median follow up was 55.1 months. There were no differences in overall survival between the two groups. The 5-year overall survival was 77.1% for those receiving post- operative radiation and 83.8% for those who did not (p = .14). On subgroup analysis by tumor location there remained no significant differences between groups. For those with tumors in the brain parenchyma, the 5-year overall survival was 77.6% for postoperative radiation compared to 85.8% for no postoperative radiation (p = .08). For those with tumors identified as being meningeal in origin, the 5-year overall survival was 75.7% for those who received postoperative radiation compared to 81.6% for those who did not receive postoperative radiation (p = .86). On multivariable analysis, postoperative radiation was not associated with any differences on survival (HR 1.35. 95% CI 0.90–2.02, p = .15). Conclusions: More than 50% of patients with hemangiopericytoma received postoperative radiation but there was no survival benefit associated with this treatment. This is a hypothesis-generating study and further studies are necessary to better determine how best to treat this rare disease. 1. Introduction Intracranial hemangiopericytoma (I-HPC) is a rare tumor that arises from pericytes within the walls of capillaries and post capillary venules. The World Health Organization considers HPC as a grade II neoplasm, with anaplastic variants considered grade III [1]. Based on limited epidemiological data, I-HPC is thought to account for 0.5% of all CNS tumors and 2.5% of all meningeal tumors [1,2]. Presentation depends on tumor location, often presenting with symptoms of increased in- tracranial pressure – headache, vertigo, nausea, vomiting, and visual disturbances. Despite mimicking meningioma in clinical and radio- graphic presentation, I-HPC is an aggressive meningeal tumor with high recurrence rates and distant metastatic disease. Diagnosis is typically confirmed with histology after resection. The current treatment options for intracranial hemangiopericytoma are surgery and radiation therapy. Surgery offers immediate relief of symptomology and histologic confirmation of diagnosis. Gross total resection can often be limited given the proximity of the tumor to vascular structures in the brain. Stereotactic radiosurgery (SRS) is uti- lized after surgical resection or tissue biopsy for an unresectable tumor. Since recurrence is noted as 3.5%, 46%, and 92% at 1, 5, and 15 years of follow up respectively, subsequent SRS is thought to be well suited in treating microscopic disease with the aim of decreasing recurrence [3]. Multiple small (< 100 patients) studies have been suggestive of a https://doi.org/10.1016/j.clineuro.2018.02.004 Received 27 November 2017; Received in revised form 31 January 2018; Accepted 2 February 2018 ⁎ Corresponding author at: Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Mail Stop #1211, Brooklyn, NY 11203, United States. E-mail address: anna.lee@downstate.edu (A. Lee). Clinical Neurology and Neurosurgery 167 (2018) 1–5 Available online 05 February 2018 0303-8467/ © 2018 Elsevier B.V. All rights reserved. T