Hypo-fractionated versus standard fractionation radiotherapy in frail and elderly patients with central nervous system solitary fibrous tumors.

Abstract

Introduction: Central nervous system solitary fibrous tumors (cSFTs) are rare, accounting for less than 1% of CNS tumors. Treatment guidelines are limited, especially for frail or elderly patients. Gross total resection followed by radiotherapy is recommended for higher-grade cases, but the role of hypofractionated radiotherapy (HF) versus standard fractionation (SF) in this population remains unclear. This study evaluates outcomes of HF compared to SF in frail patients with cSFT.

Methods: A retrospective analysis of 51 frail patients (age >65, KPS <80) with cSFT treated from 2005-2023 was performed. Patients received either HF (21 patients) or SF (30 patients). Data extracted included demographics, tumor characteristics, surgical outcomes, radiation regimens, and oncologic outcomes. Descriptive and survival analyses were conducted using Kaplan-Meier methods, with multivariable analysis via Cox regression models to assess factors influencing local control and overall survival.

Results: The median follow-up was 19 months (11-55 months). HF regimens varied from 35-48 Gy in 10-15 fractions, while SF was predominantly 54-60 Gy in 28-30 fractions. Local control was achieved in 76.2% of HF and 80% of SF patients (p=0.154). No statistical difference in overall survival was observed between HF (18 months) and SF (18 months, p=0.54). Higher tumor grade (HR=3.5, p=0.021) and incomplete resection (HR=0.72, p=0.035) negatively impacted local control. KPS ≤50 was associated with reduced survival (HR=2.3, p=0.035).

Conclusions: Hypofractionated radiotherapy appears feasible and safe for frail patients with cSFT, providing comparable outcomes to standard fractionation. The reduced treatment burden of HF may benefit patients with limited performance status. Further research is needed to guide optimal treatment approaches for this unique population.