Clinical characteristics and outcomes for a modern series of primary gliosarcoma patients

Abstract

BACKGROUND: Primary gliosarcoma (PGS) is a rare central nervous system tumor with limited experience reported in the literature. In the current study, the authors present a modern series of confirmed PGS cases treated in the era of magnetic resonance imaging (MRI), after the accepted glioblastoma management of resection, radiation, and temozolomide. METHODS: Using a retrospective review, patients with confirmed PGS were identified (1996‐2008). Cases were determined to be PGS by central pathology review using the 2007 World Health Organization criteria. Extensive chart review was performed to gather clinical and pathologic data on these cases. RESULTS: All but 1 patient had undergone a preoperative MRI, with 1 patient receiving a computed tomography scan due to a cardiac pacemaker. A total of 10 patients received radiotherapy with concurrent and adjuvant temozolomide chemotherapy, and 8 patients received radiotherapy alone or in combination with other chemotherapeutic agents. In 2 patients, the history of adjuvant treatment could not be confirmed. The overall median survival was 13.9 months (range, 2.2‐22.9 months). Patients with gliosarcomas resembling meningioma were found to have a significantly prolonged median survival compared with patients harboring gliosarcoma resembling glioblastoma multiforme (16 months vs 9.6 months; P = .011). However, no difference in survival was noted between patients who received concurrent radiotherapy and temozolomide compared with those who did not (10.4 months vs 13.9 months; P = .946). CONCLUSIONS: The results of the current study support previous hypotheses that there are 2 distinct types of PGS. The type mimicking the appearance of a meningioma appears to carry a significantly more favorable prognosis, most likely due to an increased chance at achieving macroscopic total resection. Cancer 2010. © 2010 American Cancer Society.

Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features

“…Gliosarcoma (GS) is a GBM subtype (ICD-O 9442/3) accounting for 1-5% of GBM diagnoses, and presents between ages 50 and 70, with a mean survival of 4-11.5 months [45,89,102]. Initially described by Stroebe and thought to be nondistinct from GBM in terms of age of onset, location, and clinical prognosis, significant evidence now supports GSs as a unique variant [63].…”

“…GS commonly occurs in the temporal lobes, presents as a circumscribed lesion, can have meningioma-like histological features, and can metastasize extracranially to lungs and liver [45]. GS manifestation in the spinal cord has also been reported [23].…”

Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period

“…11, [17][18][19]29,35,36,43,52,53,80,81,[86][87][88][89]98,100,101,106 Due to the reported variability of success rates for completing an awake craniotomy, along with the many published techniques and methods of performing the procedure, we decided to review the extensive experience of a single surgeon with the goal of identifying the optimal techniques and regimen to maximize perioperative safety and minimize the risk of failure for patients undergoing awake craniotomies during the removal of a glioma.…”

Assessment of treatment approach and survival outcomes in a modern cohort of patients with primary gliosarcoma using the national cancer database

“…Clinically similar to glioblastoma, GSM usually affects patients in their sixth to eighth decade of life, with a male preponderance [7,8]. The median age at diagnosis was approximately 60 years [7,[9][10][11][12].Current treatment options include surgery, radiotherapy (RT) and chemotherapy (CT) [13].…”

“…The median age at diagnosis was approximately 60 years [7,[9][10][11][12].Current treatment options include surgery, radiotherapy (RT) and chemotherapy (CT) [13]. Due to its low incidence, the current literature is limited to case reports and small cases series with insufficient evidence to guide treatment decisions.…”