Clinical Insights and Management Strategies for Gliosarcoma: A Case Report

Gliosarcoma (GSM) is a rare and aggressive variant of glioblastoma, first identified by Stroebe in 1895 and further characterized by Feigen et al. in 1955. As recognized by the WHO classification of CNS tumors in 2021, GSM features distinct biphasic histopathological characteristics that combine both glial and sarcomatous components, often resembling fibrosarcoma and occasionally displaying other mesenchymal elements. This tumor primarily affects the cerebrum, accounting for approximately 1 to 8% of all malignant gliomas, with a slight male predominance and a typical onset in individuals during their 6th and 7th decades of life. Clinically, GSM presents similarly to other brain tumors, with symptoms such as headaches, seizures, and neurological deficits resulting from mass effects and edema. Notably, gliosarcoma exhibits a higher propensity for intra- and extra-cranial metastasis than glioblastoma, complicating its management. Treatment strategies generally mirror those employed for glioblastoma, involving maximal safe surgical resection followed by adjuvant radiotherapy and temozolomide chemotherapy. However, the prognosis for patients with GSM remains particularly poor, with median survival often falling below that of glioblastoma, especially in untreated cases. The rarity of this tumor results in limited data and research, primarily confined to case reports and small series, which restricts the establishment of specific treatment protocols. Key factors influencing outcomes include the extent of surgical resection, age, and the administration of radiation therapy. There is an urgent need for further studies to explore genetic markers specific to gliosarcoma, to distinguish between primary and secondary forms of the disease, and to develop more effective, tailored treatment regimens. Addressing these gaps in knowledge could potentially enhance patient outcomes in this challenging malignancy. 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. 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.