Real-World Surgical Experience with Thoracic Solitary Fibrous Tumors: Outcomes from a High-Volume Indian Center

This study evaluates the surgical approach, role of trans-arterial angioembolization (TAE) and long-term outcomes of patients presenting with solitary fibrous tumors (SFT) to a tertiary thoracic surgical unit in India. This is a retrospective study of thoracic SFTs operated between 1 August 2008 and 31 March 2024 from our center. The clinical, radiological, and histo-pathological features, surgical outcomes, and follow-up status were retrieved from the surgical database and electronic medical records and evaluated. A total of 34 patients underwent surgical excision during the abovementioned period. The median tumor volume calculated from preoperative computed tomography images was 765.8 cm³ (range from 13 to 3740 cm³). Preoperative TAE was employed in 15 patients, all of whom had tumors larger than 10 cm in the largest dimension. Complete microscopic tumor (R0) resection was achieved in all cases. Major surgical morbidity with Clavien-Dindo grade 3 or more was seen in 11.8% (4/34) and perioperative mortality was 5.8% (2/34). Four recurrences were observed, with a disease-free interval ranging from 13 to 73 months, and no local recurrences were observed. All failures were systemic failures in the lung and had dismal outcomes despite salvage treatment. The 5-year disease-free survival and overall survival were 77% and 82%, respectively. Surgical extirpation with negative margins is the cornerstone of treatment for thoracic SFTs. Preoperative TAE is useful in the management of SFTs of 10 cm or more in size. Recurrences are late systemic failures occurring in non-low risk Demicco group patients and have poor outcomes.