The authors review the clinical and pathological features of 24 patients with gliosarcoma. The study revealed the following findings. Gliosarcoma occurs more frequently than is indicated in the literature, and in our series was present in 8% of all cases of glioblastoma multiforme. The presenting features are not significantly different from those of glioblastoma multiforme. The lesion often presents itself at surgery as a firm, well circumscribed mass within the temporal lobe, and at surgery it is commonly mistaken for a meningioma. There is an increased likelihood of metastasis compared to that of glioblastoma. The prognosis is no worse than that of glioblastoma, in spite of the addition of sarcomatous elements.

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Sixty adult patients with incompletely excised low-grade gliomas were randomly assigned to receive radiotherapy (55 Gy over a total of 6 1/2 to 7 weeks) either alone or with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU; 100 mg/sq m every 6 weeks). Pathological review showed that six patients were ineligible for the study. Evaluation of patient age, extent of surgery, tumor grade, and performance status showed no significant differences between the treatment arms. The response rate, as judged by the disappearance or reduction in size of the tumor on computerized tomography scans, was 79% for radiation therapy alone versus 54% for irradiation plus CCNU. The median survival time was 4.45 years for all patients, with no significant difference between treatment arms (p = 0.7). For the group as a whole, patient age and performance status were the most important prognostic parameters. The majority of patients receiving chemotherapy experienced moderate hematological toxicity. This study demonstrates that CCNU chemotherapy does not improve the results of radiation therapy in the treatment of incompletely excised low-grade gliomas.

The authors have analyzed 47 tumors of the central nervous system (11 glioblastomas, nine meningiomas, three medulloblastomas, 12 assorted primary neural tumors, and 12 brain metastases) for their content of macrophages. Cell suspensions were prepared by enzymatic digestion and macrophages were quantitated by IgGEAC rosette formation. Adsorption of sensitized indicator cells (EA) to sections of tumor was used as a measure to determine the distribution of IgGFc receptor-positive cells within the tumors and to serve as a control for selective release of IgGFc receptor-positive cells by enzyme digestion. The 11 glioblastomas had a mean macrophage content of 45% (range: 8% to 78%), the nine meningiomas had a mean of 44% (range: 5% to 81%), the three medulloblastomas a mean of 6% (range 2% to 15%), and the metastatic tumors a mean of 24% (range: 4% to 70%). Adsorption of EA demonstrated that IgGFc receptor-positive cells were distributed throughout the tumor mass, although different types of patterns were observed. There was an excellent correlation between the percent of IgGEAC positive cells in suspensions and the extent of EA adsorption to the tumor sections. Compared to systemic neoplasms, most nervous system tumors have a high macrophage content. It is possible that the high macrophage content of brain tumors is related to their immunogenicity, and may be a partial explanation for tha rarity of brain-tumor metastases.