The treatment of locally recurrent chondrosarcoma

Abstract

The aim of this study was to define the treatment criteria for patients with recurrent chondrosarcoma. We reviewed the data of 77 patients to examine the influence of factors such as the intention of treatment (curative/palliative), extent of surgery, resection margins, status of disease at the time of local recurrence and the grade of the tumour. A total of 70 patients underwent surgery for recurrent chondrosarcoma. In seven patients surgery was not a viable option. Metastatic disease occurred in 41 patients, appearing synchronously with the local recurrence in 56% of cases. For patients without metastasis at the time of local recurrence, the overall survival at a mean follow-up after recurrence of 67 months (0 to 289) was 74% (5 of 27) compared with 19% (13 of 50) for patients with metastasis at or before the development of the recurrence. Neither the type/extent of surgery, site of tumour, nor the resection margins for the recurrent tumour significantly influenced the overall survival. With limited survival for patients with metastatic disease at the time of local recurrence (0% for patients with grade III and de-differentiated chondrosarcoma), palliative treatment, including local radiation therapy and debulking procedures, should be discussed with the patients to avoid long hospitalisation and functional deficits. For patients without metastasis at the time of local recurrence, the overall survival of 74% justifies an aggressive approach including wide resection margins and extensive reconstruction.

Oncologic outcome after local recurrence of chondrosarcoma: Analysis of prognostic factors

“…Adequacy of surgical margins was associated with first episode of LR in high grade chondrosarcoma patients of the original cohort in this study. Of note, multiple LR in comparison with a single episode of LR was not prognostic for a worse survival (65.6% ± 20.9 vs. 57.5% ± 12, P = 0.384) which was in agreement with a previous study .…”

“…Less than one-third (9 out of 28) of the patients developed metastasis after LR with median time of 3.3 years (range, 0.1-8.0 years). In line with the previous studies, these results show that development of LR is not always a poor prognostic sign in a substantial number of patients [4,9]. Of note, all of the four patients who underwent metastatectomy were disease free until the last follow-up.…”

“…Post-LR survival of 59% at 10 years of our study is comparable to those of the previous studies [2,4,[6][7][8][9]. The relatively high survival rate after LR suggests that the development of a LR does not necessarily associate with poor survival.…”

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

“…The incidence of wide resection margins in our study was considerably lower than that reported in the literature, being only 29% when compared with 76% in the study from Streitbuerger et al 14 However, the survival rates were almost identical, which highlights the difficulty and the discrepancy that exists in defining what constitutes a wide margin or, more importantly, an adequate margin to reduce the risk of LR. 14 The DSS after LR for all patients was 42.1% at five years and 31.2% at ten years. For patients without metastases prior to, or at the time of, LR, the DSS was 62.5% and 45.5% at five and ten years, respectively.…”

Risk stratification for central conventional chondrosarcoma of bone: A novel system predicting risk of metastasis and death in the Cancer Registry of Norway cohort

“…Further subgroup analysis is needed, seeking to find whether this is valid for all CCCS or only the high risk group. Although LR has been linked to increased rates of metastasis and death in CS research, 13,32‐37 this has been performed in mixed CS cohorts and without considering immortal time bias for time dependent variables.…”