Locally recurrent chondrosarcoma of the pelvis and limbs can only be controlled by wide local excision

Abstract

Aims The purpose of this study was to investigate the potential for achieving local and systemic control after local recurrence of a chondrosarcoma of bone Patients and Methods A total of 126 patients with local recurrence (LR) of chondrosarcoma (CS) of the pelvis or a limb bone were identified from a prospectively maintained database, between 1990 and 2015 at the Royal Orthopaedic Hospital, Birmingham, United Kingdom. There were 44 female patients (35%) and 82 male patients (65%) with a mean age at the time of LR of 56 years (13 to 96). The 126 patients represented 24.3% of the total number of patients with a primary CS (519) who had been treated during this period. Clinical data collected at the time of primary tumour and LR included the site (appendicular, extremity, or pelvis); primary and LR tumour size (in centimetres); type of operation at the time of primary or LR (limb-salvage or amputation); surgical margin achieved at resection of the primary tumour and the LR; grade of the primary tumour and the LR; gender; age; and oncological outcomes, including local recurrence-free survival and disease-specific survival. A minimum two years’ follow-up and complete histopathology records were available for all patients included in the study. Results For patients without metastases prior to or at the time of local recurrence, the disease-specific survival after local recurrence was 62.5% and 45.5% at one and five years, respectively. After univariable analysis, significant factors predicting disease-specific survival were grade (p < 0.001) and surgical margin (p = 0.044). After multivariable analysis, grade, increasing age at the time of diagnosis of local recurrence, and a greater time interval from primary surgery to local recurrence were significant factors for disease-specific survival. A secondary local recurrence was seen in 26% of patients. Wide margins were a good predictor of local recurrence-free survival for subsequent recurrences after univariable analysis when compared with intralesional margins (p = 0.002) but marginal margins did not reach statistical significance when compared with intralesional margins (p = 0.084) Conclusion In cases of local recurrence of a chondrosarcoma of bone, we have shown that if the tumour is non-metastatic at re-staging, an increase in disease-specific survival and in local recurrence-free survival is achievable, but only by resection of the local recurrence with a wide margin. Cite this article: Bone Joint J 2019;101-B:266–271.

Prognostic nomograms to predict overall survival and cancer‐specific survival in patients with pelvic chondrosarcoma

“…Patients with grade IV pelvic CS had the worst prognosis, with a 5-year survival rate of 10%-20%. 26,27 In our research, we found similar 5-year survival rates for each pathological grade, which confirmed the great contribution of pathological grade to prognosis of CS in the pelvis, which was consistent with that of CS in other sites. Furthermore, the higher the pathological grade of the tumor is, the more likely it is to recur, which increases the risk of death.…”

“…Grades II and III pelvic CS tend to metastasize in the early stages, and the 5‐year survival rate was about 40% to 50% in patients with these grades of tumors. Patients with grade IV pelvic CS had the worst prognosis, with a 5‐year survival rate of 10%‐20% . In our research, we found similar 5‐year survival rates for each pathological grade, which confirmed the great contribution of pathological grade to prognosis of CS in the pelvis, which was consistent with that of CS in other sites.…”

Can clinical radiomics nomogram based on 3D multiparametric MRI features and clinical characteristics estimate early recurrence of pelvic chondrosarcoma?

“…Among the clinical risk factors, we found that tumor grade was the most important univariate predictor of ER of pelvic CS patients, which is consistent with previous studies. 2,3,9,10,35 Mavrogenis et al 2 retrospectively analyzed the survival of 215 pelvic CS patients and they found that grade was the most important univariate and multivariate predictor.…”

Chondrosarcoma local recurrence in the Cancer Registry of Norway cohort (1990–2013): Patterns and impact

“…No patient in this cohort survived both LR and metastasis combined while for those experiencing a LR without metastasis, 48% survived 10 years of follow‐up. Laitinen et al 37 report similarly 45.5% 5‐year survival in the same circumstances from a pelvic and extremity primary CS cohort.…”

“…Andreou et al 11 also present two cases of dedifferentiation in 38 LR from 115 CCCS, but do not comment on upgrading. Laitinen et al 37 report a 22% rate of increased grade from their LR CS cohort of unspecified subtype (126 cases) of extremity and pelvic locations. This includes three cases of dedifferentiation.…”