Is intralesional resection suitable for central grade 1 chondrosarcoma: A systematic review and updated meta-analysis

Chen, Xi; Yu, Ling; Peng, Huiming; Jiang, Chao; Ye, C.H.; Zhu, Shibai; Qian, Wenwei

doi:10.1016/j.ejso.2017.05.022

Cited by 58 publications

(58 citation statements)

References 46 publications

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“…Both treatment groups had excellent clinical outcome with high satisfaction, low pain, and only minimal functional impairments. Compared to other studies on intralesional resection strategy, our MSTS score results were similar and even slightly better [ 1 , 9 , 11 , 13 , 16 ].…”

Section: Discussionsupporting

confidence: 70%

Enchondromas and atypical cartilaginous tumors at the proximal humerus treated with intralesional resection and bone cement filling with or without osteosynthesis: retrospective analysis of 42 cases with 6 years mean follow-up

et al. 2018

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BackgroundEnchondromas and atypical cartilaginous tumors (ACT) are often located at the proximal humerus. Most lesions can be followed conservatively, but surgical resection may alleviate pain, avoid pathological fractures, and prevent transformation into higher grade chondrosarcomas. Rigorous intralesional resection and filling with polymethylmethacrylate bone cement has been proposed for enchondromas but also for ACT, as an alternative for extralesional resection. We intended to analyze radiological, clinical, and functional outcome of this strategy and compare bone cement without osteosynthesis to bone cement compound osteosynthesis, which has not been analyzed so far.MethodsWe retrospectively analyzed 42 consecutive patients (mean follow-up 73 months; range 8–224) after curettage and bone cement filling with or without osteosynthesis. Exclusion criteria were Ollier’s disease and cancellous bone filling. Twenty-five patients only received bone cement. Seventeen patients received additional proximal humerus plate for compound osteosynthesis to increase stability after curettage. Demographics and radiological and clinical outcome were analyzed including surgery time, blood loss, hospitalization, recurrences, and complications. An additional telephone interview at the final follow-up assessed postoperative satisfaction, pain, and function in the quick disabilities of the arm, shoulder, and hand (DASH) score and the Musculoskeletal Tumor Society (MSTS) score. Statistics included the Student T tests, Mann-Whitney U tests, and chi-square tests.ResultsNo osteosynthesis compared to compound osteosynthesis showed smaller tumors (4.2 (± 1.5) cm versus 6.6 (± 3.0) cm; p = 0.005) and smaller bone cement fillings after curettage (5.7 (± 2.1) cm versus 9.6 (± 3.2) cm; p = 0.0001). A score evaluating preoperative scalloping and soft-tissue extension did not significantly differ (1.9 (± 0.9) versus 2.0 (± 1.0); rating scale 0–4; p = 0.7). Both groups showed high satisfaction (9.2 (± 1.5) versus 9.2 (± 0.9); p = 0.5) and low pain (1.0(±1.7) versus 1.9(±1.8); p = 0.1) in a rating scale from 0 to 10. Clinical and functional outcome was excellent for both groups in the DASH score (6.0 (± 11.8) versus 11.0 (± 13.2); rating scale 0–100; p = 0.2) and the MSTS score (29.0 (± 1.7) versus 28.7 (± 1.1); rating scale 0–30; p = 0.3). One enchondroma recurrence was found in the group without osteosynthesis. Complications (one fracture and one intra-articular screw) were only detected after osteosynthesis. Osteosynthesis had longer surgery time (70 (± 21) min versus 127 (± 22) min; p < 0.0001), more blood loss (220 (± 130) ml versus 460 (± 210) ml; p < 0.0001), and longer stay in the hospital (6 (± 2) days versus 8 (± 2) days; p = 0.004).ConclusionsIntralesional tumor resection was oncologically safe and clinically successful with or without osteosynthesis. Osteosynthesis did not reduce the risk for fracture but was more invasive.

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Section: Discussionsupporting

confidence: 70%

Enchondromas and atypical cartilaginous tumors at the proximal humerus treated with intralesional resection and bone cement filling with or without osteosynthesis: retrospective analysis of 42 cases with 6 years mean follow-up

et al. 2018

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“…An atypical cartilaginous tumor (ACT) is the lowest grade of chondrosarcoma, named by the World Health Organization since 2013, which is usually challenging to distinguish from enchondroma. The differentiating features of both have been the subject of many studies so far [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Total Knee Arthroplasty and Atypical Cartilaginous Tumor/Enchondroma of the Distal Femur

et al. 2020

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Enchondroma is a common benign chondrogenic tumor, which typically occurs in the short bones of hands and feet. However, when affecting the long bones, it is difficult to rule out the low-grade chondrosarcoma, called atypical cartilaginous tumor (ACT), because of the highly similar clinical and radiologic features. This study reports 2 patients with advanced knee osteoarthritis, scheduled for total knee arthroplasty, who had a distal femoral lesion on imaging suggestive of ACT/enchondroma. We believe that the treatment of these patients could be a challenge for arthroplasty surgeons. This is because it might be difficult to decide whether a periarticular chondral tumor of an osteoarthritic knee is malignant and changes the plan. In this report, we described our approach to address both knee osteoarthritis and ACT/enchondroma of the distal femur. To the best of our knowledge, this issue has not yet been discussed in the literature.

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“…Most enchondromas do not need surgery but especially large and active ones should be radiologically followed, whereas ACT is more often treated surgically with the problem of difficult radiologic and histologic distinguishability from enchondroma [ 4 , 7 , 13 ]. Intralesional resection with curettage [ 2 , 5 , 9 – 11 , 17 , 20 , 23 , 27 ] instead of more invasive wide resection [ 10 , 28 ] is accepted as the standard surgical strategy for these rather benign to only low-malignant cartilaginous bone tumors [ 29 ]. Additional use of a high-speed burr may eliminate remaining tumor cells at the margins of the lesion by heat destruction as well as the exothermic reaction during bone cement polymerization [ 27 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical therapy of benign and low-grade malignant intramedullary chondroid lesions of the distal femur: intralesional resection and bone cement filling with or without osteosynthesis

Omlor

Lohnherr

Hetto

et al. 2018

Strategies in Trauma and Limb Reconstruction

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Surgical treatment of benign and low-grade malignant intramedullary chondroid lesions at the distal femur is not well analyzed compared to higher-grade chondrosarcomas. Localization at the distal femur offers high biomechanical risks requiring sophisticated treatment strategy, but scientific guidelines are missing. We therefore wanted to analyze a series of equally treated patients with intralesional resection and bone cement filling with and without additional osteosynthesis. Twenty-two consecutive patients could be included with intralesional excision and filling with polymethylmethacrylate bone cement alone (n = 10) or with compound bone cement osteosynthesis using a locking compression plate (n = 12). Clinical and radiological outcome was retrospectively evaluated including tumor recurrences, complications, satisfaction, pain, and function. Mean follow-up was 55 months (range 7–159 months). Complication rate was generally high with lesion-associated fractures both in the osteosynthesis group (n = 2) and in the non-osteosynthesis group (n = 2). All fractures occurred in lesions that reached the diaphysis. No fractures were found in meta-epiphyseal lesions. No tumor recurrence was found until final follow-up. Clinical outcome was good to excellent for both groups, but patients with additional osteosynthesis had significantly longer surgery time, more blood loss, longer postoperative stay in the hospital, more complications, more pain, less satisfaction, and worse functional outcome. Intralesional resection strategy was oncologically safe without local recurrences but revealed high risk of biomechanical complications if the lesion reached the diaphysis with an equal fracture rate no matter whether osteosynthesis was used or not. Additional osteosynthesis significantly worsened final clinical outcome and had more overall complications. This study may help guide surgeons to avoid overtreatment with additional osteosynthesis after curettage and bone cement filling of intramedullary lesions of the distal femur. Meta-epiphyseal lesions will need additional osteosynthesis rarely, contrary to diaphyseal lesions with considerable cortical thinning.

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Is intralesional resection suitable for central grade 1 chondrosarcoma: A systematic review and updated meta-analysis

Abstract: Intralesional resection provides lower complications and better functional outcome with no significant increase in the risk of recurrence and metastasis. We think it is a suitable treatment for central grade 1 chondrosarcoma.

Cited by 58 publications

References 46 publications

Enchondromas and atypical cartilaginous tumors at the proximal humerus treated with intralesional resection and bone cement filling with or without osteosynthesis: retrospective analysis of 42 cases with 6 years mean follow-up

Enchondromas and atypical cartilaginous tumors at the proximal humerus treated with intralesional resection and bone cement filling with or without osteosynthesis: retrospective analysis of 42 cases with 6 years mean follow-up

Total Knee Arthroplasty and Atypical Cartilaginous Tumor/Enchondroma of the Distal Femur

Surgical therapy of benign and low-grade malignant intramedullary chondroid lesions of the distal femur: intralesional resection and bone cement filling with or without osteosynthesis

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