Relationship Between Surgical Procedure and Outcome for Patients With Grade I Chondrosarcomas

Abstract

PURPOSE:To evaluate the oncological outcome of patients with grade I chondrosarcomas according to the type of surgical treatment performed, since there is still controversy regarding the need for aggressive resections to reach a successful outcome. MATERIALS AND METHODS:The records of 23 patients with grade I chondrosarcomas were reviewed. The mean age was 38.4 years, ranging from 11 to 70 years; 52% were men and 48% were women. The femur was the site of 13 tumors. The tumors were staged as IA (17, 74%) and IB (6, 26%). Regarding tumor location, 74% (17) were medullary, 22% (5) were peripheral, and 4% (1) was indeterminate. Tumor size ranged from 2 to 25 cm, mean 7.9 cm. Regarding the surgical procedure, 11 patients underwent intralesional resection, 9 patients underwent wide resection, and 3 underwent radical resection. The follow-up period ranged from 24 to 192 months. RESULTS: None of the patients developed local recurrence or metastases; 7 patients had other general complications. CONCLUSIONS:This data supports the use of less aggressive procedures for treatment of low-grade chondrosarcomas.

Low-grade chondrosarcoma of bone: experiences from the Vienna Bone and Soft Tissue Tumour Registry

“…These findings were confirmed by nearly all reports on LCS [7,[13][14][15][16][17][18][19]23]. For anatomical reasons such adjuvants are rarely applicable in the spine or pelvis, thus making intralesional resection in these locations less effective than in long bones [7].…”

“…Finally, we decided to include lesions of the hand and foot in the extremity group, which is unusual with regard to previous reports, as these lesions have been characterised by a benign clinical course [12]. But we felt that the impact of anatomical sites could be even better evaluated by both inclusion and exclusion of these lesions, as other reports [15].…”

“…The vast majority of all 70 LCS in this series were located peripherally and only 24% in the trunk; intralesional and marginal excision (together >65%) constituted the group where preservation of function was the guiding principle rather than resection margin. Most reports of extremity LCS found low rates of local recurrence even when intralesional curettage was performed ranging from 0 to 18% [7,12,[15][16][17][18][19], but rates were always higher when compared to wide resection of the tumour [7,16,18,19]. Considerations that further strengthen the rationale for limited surgery were a better functional outcome and the fact that, given appropriate approaches, subsequent treatment in extremities is not necessarily compromised by curettage [16,18].…”

“…Therefore, the evaluation of LCS as an aggressive benign tumour rather than a low-grade malignancy by some authors together with its low metastatic potential [3,5,11] have favoured a less invasive treatment at least in the long bones, i.e. intralesional curettage including the use of local adjuvants such as polymethylmethacrylate (PMMA), pasteurisation or cryosurgery [12][13][14][15]. More recent reports about extremity LCS were able to confirm that intralesional surgery was not associated with higher rates of local recurrence.…”

Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function

“…In the study by Leerapun et al [17], phenolization was used in place of cryosurgery as the adjunct, and there was only one recurrence among the 13 patients. Etchebehere et al [10] used cauterization in place of cryosurgery as the adjunct, and the recurrence rate was 0.0%. These studies are common in that (1) a form of adjunctive therapy is used (cryosurgery, phenolization, cauterization); and (2) the surgeries are performed mostly on tumors of the long bones.…”