Intralesional curettage and cementation of low-grade chondrosarcomas of the appendicular skeleton: Long-term results from a single center

Abstract

Objective: The purpose of this study was to investigate the results and complications in patients who had low-grade chondrosarcomas in the appendicular skeleton and were treated by intralesional curettage and cementation within the scope of 25 years of experience in a single center. Methods: Ninety-one patients (72 female and 19 male) were retrospectively analyzed. The median at the time of surgery was 43 (17-78) years, and the median follow-up was 102 (26-288) months. All patients were treated by intralesional curettage followed by cementation with high-viscosity bone cement (polymethylmethacrylate). Complications and local recurrence rates, as well as clinical outcome scores were recorded. Results: Five patients (5.49%) developed local recurrence at an average of 6.6 (6-9) months postoperatively. Four were treated with local-wide excision and reconstruction with tumor prosthesis. One patient received recurettage and cementation. Two recurred patients were dedifferentiated into grade II chondrosarcomas in the last intervention. No major postoperative complication was identified in the series. Patients achieved an average Musculoskeletal Tumor Society scoring system of 92.4% (standard deviation 5.2; range 80-100) in the sixth postoperative month. Musculoskeletal Tumor Society scores in the recurrent patients decreased from an average of 90% to 75.3% after the final intervention. Conclusion: Intralesional curettage and cementation seem safe and reliable techniques with low recurrence and complication rates in treating low-grade chondrosarcomas of the appendicular skeleton. Clinical, radiological, and pathological evaluations are mandatory before surgical intervention, and a multidisciplinary approach is crucial. A strict follow-up regimen in the early postoperative period is needed and strongly recommended to detect local recurrence. Level of Evidence: Level IV, Therapeutic Study

Emerging Treatments Targeting the Tumor Microenvironment for Advanced Chondrosarcoma

“…Unfortunately, most of them, including Hedgehog inhibitors that elicited good pre-clinical responses, failed to demonstrate a survival benefit when translated into clinical trials [ 38 ]. Although recent studies have demonstrated good short-term results after intralesional surgical procedures for low-grade ChSs treated with curettage and adjuvant treatments consisting of phenol application, cauterization, or cryotherapy, the primary and preferred treatment for ChS patients with localized disease remains radical surgical resection with wide margins [ 27 , 39 , 40 , 41 ]. Of note, for the management of extremity ChSs, amputation is only reserved for patients with extensive and invasive disease [ 42 ].…”