Abstract
Background: Gliosarcoma (GS) is a rare histopathologic variant of glioblastoma (GBM) characterized by a biphasic growth pattern consisting of both glial and sarcomatous components. Reports regarding its relative prognosis compared to conventional GBM are conflicting and although GS is treated as conventional GBM, supporting evidence is lacking. The aim of this study was to characterize demographic trends, clinical outcomes and prognostic variables of GS patients receiving standardized therapy and compare these to conventional GBM.Methods: Six hundred and eighty GBM patients, treated with maximal safe resection followed by radiotherapy with concomitant and adjuvant temozolomide at a single institution, were retrospectively reevaluated by reviewing histopathological records and tumor tissue for identification of GS patients. Clinico-pathological- and tumor growth characteristics were obtained via assessment of medical records and imaging analysis. Kaplan-Meier survival estimates were compared with log-rank testing, while Cox-regression modeling was tested for prognostic factors in GS patients.Results: The cohort included 26 primary gliosarcoma (PGS) patients (3.8%) and 7 secondary gliosarcoma (SGS) patients (1.0%). Compared to conventional GBM tumors, PGS tumors were significantly more often MGMT-unmethylated (73.9%) and located in the temporal lobe (57.7%). GS tumors often presented dural contact, while extracranial metastasis was only found in 1 patient. No significant differences were found between PGS and conventional GBM in progression-free-survival (6.8 and 7.6 months, respectively, p = 0.105) and in overall survival (13.4 and 15.7 months, respectively, p = 0.201). Survival following recurrence was not significantly different between PGS, SGS, and GBM. Temporal tumor location and MGMT status were found associated with PGS survival (p = 0.036 and p = 0.022, respectively).Conclusion: Despite histopathological and location difference between GS and GBM tumors, the patients present similar survival outcome from standardized treatment. These findings support continued practice of radiation and temozolomide for GS patients.
Highlights
Glioblastoma (GBM, WHO grade IV glioma) is the most common and aggressive primary brain tumor in adults with a median overall survival (OS) of around 15 months [1]
primary gliosarcoma (PGS) tumors were most often located in the temporal lobe (57.7%) followed by multilobar location (19.2%), frontal lobe (15.4%), occipital lobe (3.85%), and parietal lobe (3.85%)
While we found having a temporal tumor location being associated with improved OS among PGS patients, the radiological exploration did not reveal this to be specially associated with specific growth patterns or extent of resection (EoR)
Summary
Glioblastoma (GBM, WHO grade IV glioma) is the most common and aggressive primary brain tumor in adults with a median overall survival (OS) of around 15 months [1]. GS tumors are characterized by a biphasic growth pattern consisting of both glial components and areas of sarcomatous, mesenchymal differentiation often resembling fibrosarcoma [7]. On imaging GS lesions typically present as a well-demarcated supratentorial mass often peripherally located and abutting dura [26,27,28,29,30,31] While these imaging features are more likely to occur in GS compared to conventional GBM, it is still not possible to diagnose GS by imaging alone [27, 30]. Gliosarcoma (GS) is a rare histopathologic variant of glioblastoma (GBM) characterized by a biphasic growth pattern consisting of both glial and sarcomatous components. The aim of this study was to characterize demographic trends, clinical outcomes and prognostic variables of GS patients receiving standardized therapy and compare these to conventional GBM
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