Clinical Insights and Management Strategies for Gliosarcoma: A Case Report
Authors: Sriniva K.N , Venugopal Gowthami 
Published: November 2024

Abstract

Introduction: Gliosarcoma (GSM) is a rare, aggressive primary CNS tumor and a histopathological variant of glioblastoma, characterized by both glial and sarcomatous components. It exhibits a higher propensity for intra- and extra-cranial metastasis compared to glioblastoma and is divided into primary and secondary forms. Treatment strategies mirror those for glioblastoma, though outcomes can vary significantly. Due to its rarity, evidence on GSM treatment, clinical outcomes, and prognosis is limited primarily to case reports and small series. Case Presentation: We present two cases of gliosarcoma treated at our institute. The first case involves a 61-year-old male with a left parietal lobe tumor who presented with confusion, memory issues, and expressive dysphasia. Diagnosed with gliosarcoma, WHO grade IV, after craniotomy, he underwent gross total resection followed by radiation and Temozolomide. Despite these treatments, his cognitive function deteriorated, leading to hospice care and a 7-month survival. The second case is a 61-year-old male with a left posterior frontal mass, presenting with seizures and speech difficulties. Post-craniotomy diagnosis was gliosarcoma grade IV. Despite similar treatment, his condition worsened, and he died 5 months after surgery. Conclusion: Gliosarcoma, with its bimorphic nature and poor prognosis, exhibits a higher rate of extra-cranial metastasis and a generally worse outcome than glioblastoma. Standard treatment includes surgery, radiation, and Temozolomide, but the prognosis remains poor, influenced by factors such as age, extent of resection, and adjuvant therapy. The effectiveness of Temozolomide remains uncertain, and due to the tumor’s rarity, further research is needed to explore genetic markers, radiotherapy optimization, and novel treatments. Introduction: Gliosarcoma(GSM) is a rare primary CNS tumor and is associated with poor prognosis. It is a histopathological variant of glioblastoma and shows a bimorphic pattern with both glial and sarcomatous components. Gliosarcoma carries a greater tendency for intra and extra cranial metastasis than glioblastoma. They are further divided into primary and secondary Gliosarcoma. The treatment strategies for Gliosarcoma are similar to Glioblastoma, but studies have shown varied outcome. Evidence regarding treatment options, clinical outcomes, and prognosis of Gliosarcoma is limited to case reports and few case series owing to the rarity of the tumor. Case presentation: Here we report 2 patients of Gliosarcoma treated in our institute. A 61-year-old male with a left parietal lobe tumor initially presented with confusion, impaired short-term memory, and expressive dysphasia, which was diagnosed as gliosarcoma, WHO grade IV, following a craniotomy. Despite gross total tumor excision and subsequent adjuvant radiation and Temozolomide therapy, his cognitive function deteriorated, leading to hospice care and a 7-month overall survival. In a similar case, a 61-year-old male with a left posterior frontal mass, initially presenting with seizures and speech difficulties, was diagnosed with gliosarcoma grade IV after a craniotomy. Post-surgery, he received adjuvant radiation and Temozolomide, but his condition worsened, leading to his death 5 months after surgery. The main intent of this study is to analyze the available data on etiopathogenesis, treatment modalities and factors affecting prognosis and survival of GSM patients. Conclusion: Gliosarcoma, a rare variant of glioblastoma with both glial and sarcomatous components, has a particularly poor prognosis and a higher rate of extra cranial metastases. Although treatment strategies, including trimodality therapy (surgery, radiation, and Temozolomide), show some promise in extending survival, overall outcomes remain worse than those for glioblastoma. Key factors affecting survival include age, surgical resection extent, and adjuvant radiation. The effectiveness of Temozolomide is uncertain, and the tumor's rarity limits large-scale research. Further studies are needed to explore genetic markers, dose escalation in radiotherapy, and novel therapies to improve treatment outcomes.