The role of surgery plus radiation versus surgery alone in the management for complicated orbital solitary fibrous tumor: a new insight on a rare disease

Orbital solitary fibrous tumor is extremely rare, and the therapeutic role of radiotherapy remains poorly defined. This study aimed to compare long-term prognosis between surgery plus radiotherapy and surgery alone in complicated orbital solitary fibrous tumor (OSFT), thereby providing evidence-based insights for clinical management. In this retrospective cohort study, we analyzed OSFT patients treated over a decade (January 2013-December 2023). Inclusion criteria encompassed cases with tumor recurrence or histopathological confirmation of anaplastic /malignant variants. By excluding benign cases without recurrence, we could specifically examine the impact of radiotherapy on disease control in complicated OSFTs. Clinico-demographic parameters including age, gender, histopathological subtype, surgical intervention, and radiotherapy administration were collected. Patients were stratified into two treatment arms: surgery alone ( n = 19) versus surgery with adjuvant radiotherapy ( n = 15). Kaplan-Meier methodology was employed to evaluate recurrence-free survival (RFS) and overall survival (OS), with between-group comparisons using log-rank tests. Cox proportional hazards models were implemented for prognostic factor analysis. From 60 screened OSFT cases, 34 met inclusion criteria: 13 anaplastic, 11 malignant, and 10 recurrent tumors at presentation. The surgery combining radiotherapy cohort demonstrated superior 3-year (88.9% vs. 51.3%) and 5-year RFS (88.9% vs. 44.0%) compared to surgery alone ( P = 0.036). A self-controlled analysis of irradiated patients revealed significant post-radiotherapy reduction in recurrence rates ( P = 0.025). Univariate Cox analysis identified radiotherapy administration as the sole independent prognostic factor (HR = 0.24). Long-term follow-up demonstrates that adjuvant radiotherapy combined with surgical resection significantly enhanced local control in complicated OSFT, with acceptable radiation-related toxicity profiles.