How would you manage a hemangioendothelioma with brain invasion s/p partial resection?

Hemangioendotheliomas are extremely rare, mostly benign but sometimes malignant, tumors of endothelial blood vessel cells that exist on a spectrum of aggression somewhere in between hemangiomas and angiosarcomas.

Guidelines for their treatment are garnered from small case series and case reports.

Resection is the treatment of choice. Adjuvant radiation has been used in cases of unresectable recurrence, e.g. 59.4Gy/33fx.

A partially resected specimen with brain invasion likely exists on the malignant end of the spectrum and should be managed more aggressively. I would favor adjuvant RT. It is reasonable to consider SRS or hypofractionated treatment. I would use an AVM-appropriate dose, either 17.5-20Gy/1fx or 35-40Gy/5fx.

TKI's have also b...