Abstract
Purpose
Primary pediatric gliosarcoma (pPGS) is an extremely rare entity with only 25 cases reported in the English literature. The value of concurrent and adjuvant temozolomide is not known in this group of patient.
Methods
Five patients of pPGS treated from 2006 to 2011 were included in this retrospective analysis. All patients underwent maximal safe surgical resection. Adjuvant therapy included conformal radiation 60 Gy in 30 fractions (2 Gy daily for 5 days in a week) with concurrent temozolomide 75 mg/m2 daily followed by six cycles of maintenance temozolomide 150–200 mg/m2 (day 1 to day 5) every 4 weeks. We combined the survival data of 25 patients (already published) and five of our patients and analyzed them in terms of progression free survival (PFS) and overall survival (OS) using Kaplan–Meier method.
Results
Male to female ratio was 1:4 and median age was 12 years (range, 7–19 years). All but one patient underwent gross total resection and four patients completed adjuvant radiotherapy as well as concurrent and adjuvant temozolomide. At a median follow up of 22.6 months (range, 0 to 45.3 months), two patients were dead and two were alive without disease while one was lost to follow up. For the pooled data, estimated median PFS and OS of all 30 patients reported in literature were 12 and 43 months, respectively. Two years PFS and OS rate for all patients was 44.2 and 62.9 %, respectively.
Conclusion
Adjuvant radiotherapy and temozolomide is well tolerated and show an encouraging survival in pPGS.
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References
Schwartzbaum JA, Fisher JL, Aldape KD, Wrensch M (2006) Epidemiology and molecular pathology of glioma. Nat Clin Pract Neurol 2:494–503
Karremann M, Rausche U, Fleischhack G, Nathrath M, Pietsch T, Kramm CM, Wolff JE (2010) Clinical and epidemiological characteristics of pediatric gliosarcomas. J Neuro-Oncol 97:257–265
Martin J, Devadoss P, Kannan K, Kumar Sundarraj S (2014) Malignant pediatric gliosarcoma defies general survival data. Case Rep Med 2014:175679
Neelima R, Abraham M, Kapilamoorthy TR, Hingwala DR, Radhakrishnan VV (2012). Pediatric gliosarcoma of thalamus 60:674–6
Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al (2009) Effects of radiotherapy with concomitant and adjuvanttemozolomideversus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466
Mallick S, Gandhi AK, Joshi NP, Kumar A, Puri T, Sharma DN, et al (2015) Outcomes of pediatric glioblastoma treated with adjuvant chemoradiation with temozolomide and correlation with prognostic factors. Indian J Med Paediatr Oncol 36:99–104
Singh G, Mallick S, Sharma V, Joshi N, Purkait S, Jha P, et al (2012) A study of clinico-pathological parameters and O -methylguanine DNA methyltransferase (MGMT) promoter methylation status in the prognostication of gliosarcoma. Neuropathology 32:534–542
Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, et al (2005) MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 352:997–1003
Srivastava A, Jain A, Jha P, Suri V, Sharma MC, Mallick S, et al (2010) MGMT gene promoter methylation in pediatric glioblastomas. Childs Nerv Syst 26:1613–1618
Kang SH, Park KJ, Kim CY, Yu MO, Park CK, Park SH, et al (2011) O6-methylguanine DNA methyltransferase status determined by promoter methylation and immunohistochemistry in gliosarcoma and their clinical implications. J Neuro-Oncol 101:477–486
Salvati M, Caroli E, Raco A, Giangaspero F, Delfini R, Ferrante L (2005) Gliosarcomas: analysis of 11 cases do two subtypes exist? J Neuro-Oncol 74:59–63
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Mallick, S., Gandhi, A.K., Sharma, D.N. et al. Pediatric gliosarcoma treated with adjuvant radiotherapy and temozolomide. Childs Nerv Syst 31, 2341–2344 (2015). https://doi.org/10.1007/s00381-015-2919-8
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DOI: https://doi.org/10.1007/s00381-015-2919-8