Brain Necrosis as a Consequence of Reirradiation in Meningeal Hemangiopericytoma: A Case Report and Review of the Literature

Meningeal hemangiopericytoma is a rare tumor in central nervous system (CNS), consisting of less than one percent in incidence. It has distinctive characteristics of being slow in tumor progression and high in tumor recurrence. Unlike other CNS tumor, there exists also risk of neuroaxis and distant metastasis. Due to repeated recurrence, the presented case had received two full courses of irradiation to tumor bed with an interval of five years. The cumulative dose in the overlapped region of brain is greater than 100Gy, overt brain necrosis developed with progressive neurologic symptoms at seven months after second radiotherapy. After surgical decompression and removal of necrotic mass, the patient is still alive at present with improved neurologic symptoms. As a matter of fact, this patient has been alive for over 14 years since the first time that she found out about her brain tumor. After review of papers, we conclude that radiation induced brain necrosis may be expected in reirradiation, but not every case reirradiated results in brain necrosis with clinically severe neurologic deficit or mortality. If there is survival benefit and/or symptomatic improvement, reirradiation in the CNS may be considered in selected case.