Objective:

To systematically review the latest advances in comprehensive postoperative treatments for CNS solitary fibrous tumors (SFTs) and provide guidance for reducing postoperative recurrence and metastasis.

Approach:

• Surgical Resection: Maximal safe surgical resection is emphasized as the cornerstone of local control, although achieving gross-total resection is often challenging.
• Postoperative Radiotherapy: Postoperative radiotherapy is recommended for patients with subtotal resection or high-risk pathological features to improve local control rates.
• Systemic Therapy: Anti-angiogenic agents like pazopanib show superior disease control compared to conventional chemotherapy in advanced cases, while cytotoxic chemotherapy is reserved for refractory subtypes.
• Immunotherapy: Immunotherapy, including PD-1/PD-L1 inhibitors, has shown limited but promising activity, with PRAME as a potential target.
• Multidisciplinary Approach: Optimal management requires a multidisciplinary team approach, tailoring treatment based on individual patient factors.
• Surveillance: Lifelong regular MRI surveillance is crucial for early detection of recurrence.

Key Findings:

• Postoperative recurrence rates can be as high as 43%.
• Maximal safe surgical resection significantly reduces recurrence risk.
• Postoperative radiotherapy improves local control for high-risk patients.
• Anti-angiogenic agents are more effective than conventional chemotherapy in advanced cases.
• Immunotherapy shows limited promise in select patients.

Interpretation:

The review highlights the complexity of managing CNS SFTs and the need for individualized treatment strategies.

Limitations:

• Most studies are limited to case reports or small retrospective series.
• There is a lack of large-scale, prospective clinical trial data.

Conclusion:

Future research should focus on prospective clinical trials and exploring combination therapies to improve outcomes for CNS SFT patients.