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- Question: We are facing a gliosarcoma and have just finished phase 1 of treatment (radiation and temador) with our first follow-up MRI tomorrow. What is the latest data on how now to best proceed?
Best practice is to follow GBM guidelines. See below:
J Neurosurg. 1998 Sep;89(3):425-30.
Clinical outcome of gliosarcoma compared with glioblastoma multiforme: North
Central Cancer Treatment Group results.
Galanis E, Buckner JC, Dinapoli RP, Scheithauer BW, Jenkins RB, Wang CH,
O'Fallon JR, Farr G Jr.
Department of Oncology, Mayo Clinic and Mayo Foundation, Rochester,
Minnesota 55905, USA.
OBJECT: Gliosarcoma, a rare malignancy of the central nervous system,
consists of gliomatous and sarcomatous elements. There are conflicting
reports regarding its aggressiveness and cell line of origin compared with
those of glioblastoma multiforme (GBM). The goal of this study was to
compare clinicopathological features such as disease-free survival time and
actual survival time in patients with gliosarcoma with a matched group of
patients with GBM as well as with the entire group of patients with GBM.
METHODS: The authors report on 18 cases of gliosarcoma derived from a series
of 748 Grade 4 astrocytoma cases that were part of four consecutive
randomized Phase III trials conducted between 1979 and 1996. In this series
the gliosarcoma group represented only 2.4% of all GBMs and included 11 men
and seven women with a median age of 61.5 years (range 31-81 years). The
median tumor size was 5 cm (range 2-8 cm). The locations, all
supratentorial, included temporal in 44%, parietal in 28%, frontal in 17%,
and occipital in 11%. The 18 patients with gliosarcomas, all Grade 4 (World
Health Organization classification), were compared with the entire group of
730 patients with GBM and a control group of 18 patients with GBM matched
for known prognostic factors including patient age, randomization date,
performance status, extent of resection, and protocol number. Patients in
all treatment groups received radiation and nitrosourea-based chemotherapy.
The median time to progression and the median survival times for the
patients with gliosarcoma were 28.0 and 35.1 weeks as compared with 24.7 and
41.6 weeks for the entire group of patients with GBM (log rank test, p =
0.94 and 0.27, respectively) and 16.7 and 34.4 weeks in the control group (p
= 0.20 and 0.84, respectively). In previous molecular cytogenetic analyses
of gliosarcoma these authors have shown similar genetic changes in the
gliomatous and sarcomatous components.
CONCLUSIONS: The data obtained in this study support the conclusion that
gliosarcoma shares significant clinical and genetic similarities with GBM
and that the same principles should be applied for patient enrollment in
research protocols and treatment for these two kinds of tumor.