DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.023

Pages: 2501-2506

Gliosarcoma is a rare variant of isocitrate dehydrogenase IDH-wildtype glioblastoma. Its association with a gliomatosis cerebri growth pattern remains an exceptional occurrence. This case concerns a 51-year-old female presenting with a focal right occipital mass. Histopathology following subtotal resection confirmed gliosarcoma. Despite preserved neurological status post-surgery, magnetic resonance imaging performed four weeks subsequently demonstrated a dramatic aggravation. Imaging demonstrated a Type 2 gliomatosis pattern: a focal enhancing mass and massive, non-enhancing bi-hemispheric infiltration extending through the corpus callosum. The patient was managed with concurrent chemoradiotherapy utilizing Volumetric Modulated Arc Therapy (VMAT) with Simultaneous Integrated Boost (SIB), delivering 60 Gy to macroscopic disease and 54 Gy to the infiltrative component. Despite this aggressive approach, the patient succumbed to rapid disease progression three months after completion of radiotherapy. This report underscores the profound radio-clinical discordance characterized by preserved clinical status masking fulminant radiological aggravation. Furthermore, it highlights the complex radiotherapy challenges, particularly the dilemma of dose prescription, balancing therapeutic efficacy against neurotoxicity in such extensive disease.