Article
Primary and secondary gliosarcoma – differences in treatment and outcome
Primäre und sekundäre Gliosarkome – Unterschiede bei der Behandlung und den Ergebnissen
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Authors
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Bujung Hong
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Deutschland
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Michael Lalk
- Medizinische Hochschule Hannover, Klinik für Diagnostische und Interventionelle Neuroradiologie, Hannover, Deutschland
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Bettina Wiese
- Medizinische Hochschule Hannover, Klinik für Diagnostische und Interventionelle Neuroradiologie, Hannover, Deutschland
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Roland Merten
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Deutschland
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Hans E. Heissler
- Medizinische Hochschule Hannover, Klinik für Diagnostische und Interventionelle Neuroradiologie, Hannover, Deutschland
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Peter Raab
- Medizinische Hochschule Hannover, Klinik für Diagnostische und Interventionelle Neuroradiologie, Hannover, Deutschland
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Christian Hartmann
- Medizinische Hochschule Hannover, Institut für Pathologie, Hannover, Deutschland
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Joachim K. Krauss
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Gliosarcoma - regarded as a rare variant of glioblastoma - has been observed in approximately 2% of patients with malignant gliomas. While treatment and outcome of patients with gliosarcoma has received more attention over the past decade, only few studies compared differences in primary versus secondary gliosarcoma. In this report we aimed to analyze the impact of surgical resection on the one hand and to evaluate outcome comparing patients with primary versus secondary gliosarcoma on the other.
Methods: Twenty patients underwent microsurgical resection for supratentorial gliosarcoma within a period of 10 years at our institution. Patients with primary gliosarcoma (n=10) were compared to patients with secondary gliosarcoma (n=10). Treatment history of gliosarcoma, including surgical resection and adjuvant postoperative therapy were retrospectively reviewed. Follow-up data, progression-free survival (PFS) and overall survival (OS) were evaluated.
Results: The mean age of patients with primary gliosarcoma was 60.0 ± 15.0 years, and that of patients with secondary gliosarcoma was 54.8 ± 12.2 years. The median follow-up time of all patients was 18 months. The median PFS in patients with primary gliosarcoma was significantly higher than in patients with secondary gliosarcoma (10.5 months vs. 4.0 months; p=0.01). The 6-month PFS rates were 80.0% in patients with primary and 30.0% in patients with secondary gliosarcoma. Upon recurrence, 6 patients with primary gliosarcoma and 4 patients with secondary gliosarcoma underwent repeat surgical resection. At the last follow-up, 18 patients hat succumbed to the disease and 2 patients were still alive. The mOS of patients with primary gliosarcoma was significantly higher than that of patients with secondary gliosarcoma (13.5 months vs. 6.5 months; p=0.01). The 1-year and 2-year survival rate in patients with primary gliosarcoma was 70.0% and 20.0%, respectively, in patients with secondary gliosarcoma it was 10.0% and 10.0%, respectively. The mOS of patients with primary gliosarcoma who underwent repeated surgery for tumor recurrence was significantly higher than that of patients with secondary gliosarcoma (18 months vs. 8 months; p=0.016).
Conclusion: Patients with primary gliosarcoma benefit much more from surgical resection in comparison to those with secondary gliosarcoma who already presented with a recurrent tumor - both with regard to PFS and mOS. In case of tumor recurrence, patients with secondary gliosarcoma have an unfavorable prognosis with limited further options.
