Gliosarcomas: analysis of 11 cases do two subtypes exist?

Abstract

There are conflicting reports regarding gliosarcomas. The goal of this study is to examine clinical, radiological, surgical and therapeutic aspects of 11 patients with gliosarcoma. Between 1993 and 2001, 11 patients with cerebral gliosarcoma were treated at our Institute. Ten patients underwent surgery and one patient had stereotactic biopsy. Four patients received whole brain radiotherapy with (60)Co, five underwent radiotherapy with LINAC extended 2 cm beyond the edema margins. One patient refused any additional treatment after surgery and one patient was not treated postoperatively for poor clinical conditions (KPS 40). Chemotherapy (temozolomide) was administered to four patients. Four patients had a prevalence of sarcomatous component that corresponded to surgical and radiological aspects similar to meningioma while six patients showed a prevalence of gliomatous component and radiological and surgical aspects similar to those of glioblastomas. Surgical resection was total in six and subtotal in four patients. Patients with prevalent sarcomatous component showed median survival time more prolonged than patients with prevalent gliomatous component (71 +/- 6 weeks vs. 63 +/- 6; P=0.0417). Moreover, the survival rate differed in relation to the therapy: patients treated with multimodality therapy (surgery, radiotherapy and chemotherapy) had a longer survival time than patients treated in single or bimodality. Despite prognosis of gliosarcomas remains poor, a multidisciplinary approach (surgery, radiotherapy and chemotherapy) seems to be associated with slight more prolonged survival times.

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

“…31 In a series of 11 patients, Salvati et al also proposed the existence of 2 distinct types of PGS based on appearance, and these authors were able to demonstrate a statistically significant difference in survival between the 2 groups. 16 In the current series, there was a significantly longer survival noted in the group of PGS patients with tumors resembling meningiomas. Patients in both groups underwent similar treatments.…”

“…5,10,[12][13][14][15][16][17] However, the majority of these studies did not specify a diagnosis of PGS, and included a mixture of both de novo and secondary gliosarcomas. The report by Perry et al in 1995 suggested a more favorable prognosis in patients with secondary gliosarcoma, underscoring the importance of keeping the primary type and gliosarcoma diagnosed at disease recurrence of prior malignant glioma distinct.…”

“…To the best of our knowledge, all the large published case series, including the latest by Salvati et al published in 2005, predate the currently accepted treatment regimen using surgical resection followed by radiotherapy with adjuvant temozolomide for patients with GBM. 16 …”

“…The mean age in the sixth decade and the higher proportion of males noted in the patients in the current study are features consistent with previous reports describing the demographic similarity of patients with PGS and GBM. 5,15 Several studies have found that PGS is most commonly localized to the temporal lobe, 5,10,14,16 whereas other reports indicate a highest incidence in the frontal lobe. 12,15 In the current series, the frontal lobe was the most frequent location, accounting for 45% of cases.…”

Temporal Gliosarcoma With Extraneural Metastasis -Case Report-

“…Patients with highly sarcomatous gliosarcomas have recently survived longer than patients with predominantly gliomatous gliosarcomas. 4,11) In the present case, the sarcomatous component was predominant but the tumor showed rapid recurrence, with extension into the infratemporal fossa and lung metastasis. Both the disease-free survival time and the actual survival time were extremely short.…”