title: Clinical outcome of patients with primary gliosarcoma treated with concomitant and adjuvant temozolomide: A single institutional analysis of 27 cases.
abstract: OBJECTIVE
  The prognosis of primary gliosarcoma (PGS) remains dismal with current treatment modalities. We analyzed the outcome of PGS patients treated with concurrent and adjuvant temozolomide (TMZ).
  
  
  METHODS
  Retrospective single institutional analysis.
  
  
  METHODS
  We retrospectively evaluated 27 patients of PGS treated with radiotherapy (RT) and TMZ during 2007-2012.
  
  
  METHODS
  Overall survival (OS) was estimated by the use of Kaplan Meier method and toxicities were evaluate using common terminology criteria for adverse events version 2.0 (National Cancer Institute, USA).
  
  
  RESULTS
  Median age at presentation and Karnofsky performance status was 45 years and 90 respectively and male: female ratio was 20:7. Patients received adjuvant RT to a total dose of 60 Gy at 2 Gy/fraction. All patients except 5 received adjuvant TMZ to a median number of 6 cycles. Grade 2 and 3 hematological toxicity was seen in 8% and 4% of patients respectively during concurrent RT. During adjuvant chemotherapy, 13.6% had Grade 3 thrombocytopenia and 9.5% had Grade 3 neutropenia. Median OS was 16.7 months (1 year and 2 year actuarial OS was 70.8% and 32.6% respectively). Adjuvant TMZ was associated with a better survival (median survival 21.21 vs. 11.93 months; P = 0.0046) on univariate analysis and also on multivariate analysis (hazard ratio 1.82, 95% confidence interval: 1.503-25.58; P = 0.012).
  
  
  CONCLUSIONS
  The results of our study, largest series of patients with PGS treated with concurrent and adjuvant TMZ shows an impressive survival with acceptable toxicity. We suggest TMZ be included in the "standard of care" for this tumor.
authors.affiliation: Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: G K
authors.initials: GK
authors.lastname: Rath
authors.forename: D N
authors.initials: DN
authors.lastname: Sharma
authors.forename: S
authors.initials: S
authors.lastname: Mallick
authors.forename: A K
authors.initials: AK
authors.lastname: Gandhi
authors.forename: N P
authors.initials: NP
authors.lastname: Joshi
authors.forename: K P
authors.initials: KP
authors.lastname: Haresh
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: P K
authors.initials: PK
authors.lastname: Julka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D018316:Gliosarcoma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077204:Temozolomide; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide