Gliosarcoma: A Multi-Institutional Analysis on Clinical Outcomes and Prognostic Factors

Siyer Roohani ^1,2,3, Maximilian Mirwald ¹, Felix Ehret ^1,3

¹Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²BIH Charité Junior Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany.
³German Cancer Consortium (DKTK), partner site Berlin, a partnership between DKFZ and Charité-Universitätsmedizin Berlin, Germany, Heidelberg, Germany.
⁴Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.
⁵National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
⁶National Center for Tumor Diseases (NCT), Heidelberg, Germany.
⁷Department of Internal Medicine II, Oncology/Hematology/BMT/Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁸Department of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, Freiburg, Germany.
⁹German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany.
¹⁰Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
¹¹Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹²Research Institute Children's Cancer Center Hamburg, Hamburg, Germany.
¹³Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁴Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
¹⁵Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.

⁰Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

Cancer Medicine +

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November 15, 2024

View abstract on PubMed

Summary

Trimodal therapy (surgery, radiotherapy, chemotherapy) improves survival for gliosarcoma (GSM) patients. Younger age, smaller tumors, and methylated MGMT promoters are favorable prognostic factors for GSM.

Area Of Science

Neuro-oncology
Surgical Oncology
Radiation Oncology
Medical Oncology

Background

Gliosarcomas (GSM) are rare and aggressive primary brain tumors.
Optimal treatment strategies and prognostic factors for GSM remain incompletely defined.

Purpose Of The Study

To describe oncological outcomes in patients with gliosarcoma (GSM).
To investigate prognostic factors influencing survival in GSM patients.

Main Methods

Retrospective analysis of 170 histopathologically confirmed GSM patients from five European institutions.
Evaluation of treatment modalities including surgery, postoperative radiotherapy (pRT), and temozolomide (TMZ)-based chemotherapy.
Multivariable Cox regression analysis (MVA) to identify significant prognostic factors for overall survival (OS) and progression-free survival (PFS).

Main Results

The median OS and PFS were 12.3 and 6.6 months, respectively.
Trimodal therapy (surgery, pRT, TMZ chemotherapy) was associated with improved survival.
Significant prognostic factors for OS included younger age, gross total resection (GTR), pRT, TMZ chemotherapy, methylated MGMT promoter, and smaller tumor diameter.
Significant prognostic factors for PFS included GTR, pRT, TMZ chemotherapy, unknown MGMT promoter status, and smaller tumor diameter.

Conclusions

Trimodal therapy appears to be the most beneficial treatment approach for GSM.
Factors associated with improved survival include younger age, smaller tumor size, and methylated MGMT promoters.
This study represents the largest multi-institutional cohort investigating outcomes and prognostic factors for GSM.

Keywords:

MGMT TP53 gliosarcoma outcomes prognostic factors radiotherapy surgery

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