Extended Intralesional Treatment versus Resection of Low-grade Chondrosarcomas

Abstract

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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

“…Many authors recommend observation as a first line of treatment for cartilaginous bone tumors of uncertain malignant potential [1,14,29]. However, in certain cases, because of patient concerns, tumor-specific pain, or radiographic findings suggesting a low-grade expanding lesion, surgery is indicated.…”

“…We chose 18 months as a minimum followup based on the median time to local recurrence reported in similar studies [1,4,6,14,17,30,31]. Of the 68 patients, 46 (68%) had at least 18 months followup.…”

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

“…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].…”

“…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]. The role of local recurrence and its impact on survival, however, is critical, because local recurrence might be interpreted as an aggressive phenotype of LCS [23] and therefore can dedifferentiate into higher grade lesions with metastatic potential [7].…”

“…More recent reports about extremity LCS were able to confirm that intralesional surgery was not associated with higher rates of local recurrence. Additionally, functional results were better and complication rates were lower [7,[16][17][18][19]. The majority of these reports were limited to long bone lesions and did not reflect data concerning truncal LCS.…”