Evaluating Surgical Resection Extent and Adjuvant Therapy in the Management of Gliosarcoma

Michael C Jin; Elisa K Liu; Siyu Shi; Iris C Gibbs; Reena Thomas; Lawrence Recht; Scott G Soltys; Erqi L Pollom; Steven D Chang; Melanie Hayden Gephart; Seema Nagpal; Gordon Li

doi:10.3389/fonc.2020.00337

Evaluating Surgical Resection Extent and Adjuvant Therapy in the Management of Gliosarcoma

Front Oncol. 2020 Mar 11:10:337. doi: 10.3389/fonc.2020.00337. eCollection 2020.

Authors

Michael C Jin¹, Elisa K Liu¹, Siyu Shi², Iris C Gibbs^{1

3}, Reena Thomas³, Lawrence Recht^{1

3}, Scott G Soltys^{1

3}, Erqi L Pollom^{1

3}, Steven D Chang^{1

2}, Melanie Hayden Gephart^{1

3}, Seema Nagpal^{1

3}, Gordon Li^{1

3}

Affiliations

¹ Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.
² Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, United States.
³ Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States.

Abstract

Introduction: Gliosarcomas are clinically aggressive tumors, histologically distinct from glioblastoma. Data regarding the impact of extent of resection and post-operative adjuvant therapy on gliosarcoma outcomes are limited. Methods: Patients with histologically confirmed gliosarcoma diagnosed between 1999 and 2019 were identified. Clinical, molecular, and radiographic data were assembled based on historical records. Comparisons of categorical variables used Pearson's Chi-square and Fisher's exact test while continuous values were compared using the Wilcoxon signed-rank test. Survival comparisons were assessed using Kaplan-Meier statistics and Cox regressions. Results: Seventy-one gliosarcoma patients were identified. Secondary gliosarcoma was not associated with worse survival when compared to recurrent primary gliosarcoma (median survival 9.8 [3.8 to 21.0] months vs. 7.6 [1.0 to 35.7], p = 0.7493). On multivariable analysis, receipt of temozolomide (HR = 0.02, 95% CI 0.001-0.21) and achievement of gross total resection (GTR; HR = 0.13, 95% CI 0.02-0.77) were independently prognostic for improved progression-free survival (PFS) while only receipt of temozolomide was independently associated with extended overall survival (OS) (HR = 0.03, 95% CI 0.001-0.89). In patients receiving surgical resection followed by radiotherapy and concomitant temozolomide, achievement of GTR was significantly associated with improved PFS (median 32.97 [7.1-79.6] months vs. 5.45 [1.8-26.3], p = 0.0092) and OS (median 56.73 months [7.8-104.5] vs. 14.83 [3.8 to 29.1], p = 0.0252). Conclusion: Multimodal therapy is associated with improved survival in gliosarcoma. Even in patients receiving aggressive post-operative multimodal management, total surgical removal of macroscopic disease remains important for optimal outcomes.

Keywords: adjuvant; brain tumor; glioblastoma; gliosarcoma; neurosurgery; temozolomide.