gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Primary Gliosarcoma in adults: Clinical characteristics, Management and Outcomes in a series from a single German institution

Meeting Abstract

  • Victoria Kuhna - Evangelisches Krankenhaus – Universität Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
  • Juan-Manuel Viñas-Rios - Oldenburg, Deutschland
  • Thomas Kretschmer - Oldenburg, Deutschland
  • Thomas Schmidt - Universitätsklinik für Neurochirurgie Oldenburg, Evangelisches Krankenhaus-Universität Oldenburg, Oldenburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 021

doi: 10.3205/17dgnc584, urn:nbn:de:0183-17dgnc5845

Published: June 9, 2017

© 2017 Kuhna et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Primary gliosarcoma (PGS) is a malignant central nervous system tumor composed of glial and mesenchymal components. Comprising approximately 1-8% of all malignant gliomas, the incidence is exceedingly rare. Though being considered a variant of glioblastoma (GBM), gliosarcoma only comprise 2% of all GBMs but feature an even worse prognosis and cannot be distinguished clinically. Due to the limited knowledge about this entity and resultant lack of large monocentric studies, we performed a retrospective study analyzing clinical, radiological, histopathological data as well as treatment regiments from patients with PGS at a single institution in Germany.

Methods: Between 2000 and 2016, a total of 9 patients with primary gliosarcoma were diagnosed at our institution. Demographics, clinical presentation, radiological, features and treatment regimen were retrospectively reviewed and analyzed for these histologically proven cases with PGS.

Results: All patients were males with a mean age of 60,2 (range:38-72 years) at time of presentation. Initial presentation and symptoms correlated with the location of the intracranial lesion and included headache and psychomotor retardation (77,8% n=7), diziness (55,6% n=5), paresis (33,3% n=3), aphasia and/or vision impairment (33,3% n=3) as well as seizures (11,1% n=1). Based upon neuroradiological imaging, average tumor size was 52,1mm x 49,25mm x 48,3mm though its mass effect was notibly bigger as the tumor and its perivascular edema involved an average area of 83,5mm x 52,8mm x 60,1mm in MRI-T2 imaging causing an average midline shift of 7,2mm. The extent of brain involvement and proliferative index Ki-67 did not correlate significantly with the length of overall survival (OS). Low KPS did correlate with short OS. Furthermore, age at presentation and the extend of surgical resection was a significant predictor of OS. Contrary to GBM, OS was not associated with MGMT methylation status and adjuvant radiotherapy did not seem to influence OS.

Conclusion: Our data underline the therapeutic challenges associated with PGS. Though surgical resection combined with chemoradiation is significantly associated with GBM survival, applying similar treatment protocols for PGS should be reconsidered due to its more aggressive clinical behavior and worse prognosis. Although not statistically significant, patients recieving postsurgical chemoradiation did not show a better trend in OS than patients recieving chemotherapy with TMZ postsurgically only.