Late Progression of a Residual Solitary Fibrous Brain Tumor after Subtotal Resection and Adjuvant Radiotherapy: A Case Report

Background: Intracranial solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms with an unpredictable clinical course. While gross total resection is associated with improved local control, residual tumor may persist and exhibit late progression, even after adjuvant radiotherapy. Case Presentation: We report a 35-year-old man who initially underwent subtotal resection of a tentorial SFT, followed by adjuvant fractionated radiotherapy. Regular MRI follow-up over four years showed stable residual disease. The patient later developed symptoms of intracranial hypertension, and imaging revealed significant tumor progression at the previous surgical site. A second subtotal resection was performed, confirming WHO grade II SFT. Postoperatively, the patient received three cycles of VAC chemotherapy, resulting in a reduction of residual tumor volume, with plans for additional cycles. Discussion: This case underscores the potential for late progression of residual intracranial SFTs, even in low-grade lesions and after adjuvant radiotherapy. Gross total resection remains the optimal management strategy, but anatomical constraints often limit resection. Systemic therapy may provide additional benefit in selected cases, while emerging targeted agents represent promising options for progressive or metastatic disease. Conclusion: Late progression of residual SFTs necessitates lifelong radiological surveillance. Early recognition of progressive disease allows timely surgical and medical interventions to optimize patient outcomes.