Relationship between surgical procedure and outcome for patients with grade I chondrosarcomas (original) (raw)
Related papers
Surgical Treatment of Grade I Central Chondrosarcoma
Clinical Orthopaedics and Related Research®, 2010
The grade of chondrosarcoma relates to the likelihood of local recurrence and metastases. Many Grade I chondrosarcomas behave benignly if aggressively, and the question arises regarding whether wide resection is essential to control the disease. We therefore asked whether intralesional surgery also could be extended to Grade I chondrosarcomas without an increase in recurrence. We retrospectively reviewed 31 patients with Grade I chondrosarcomas of the limbs. The minimum followup was 66 months (mean, 157 months; range, 66-296 months). None of the 16 patients treated by resection had recurrences during the followup and two of the 15 patients with intralesional excision had recurrences, both of which resolved with resection of the site involved by the recurrence without progression of the disease. The Musculoskeletal Tumor Society scores averaged 72% in patients treated with wide resection compared with 89% in the 15 patients treated by intralesional surgery. The two recurrences occurred in patients whose radiographs showed thinning of the cortex combined with bone enlargement and marked endosteal scalloping; histologic examination in these two patients also showed a correlation between radiographic aggressiveness and the presence of myxoid areas and hypercellularity.
Chondrosarcoma of Bone: Lessons From 46 Operated Cases in a Single Institution
Clinical Orthopaedics and Related Research®, 2010
Background Bone chondrosarcomas are rare malignant tumors that have variable biologic behavior, and their treatment is controversial. For low-grade tumors, there is no consensus on whether intralesional en bloc resections are the best treatment. Questions/purposes We therefore compared patients with Grade 1 and Grade 2 primary central chondrosarcomas to (1) determine difference in survival and (2) local recurrence rates; and (3) determine any association of histological grade with some clinical and demographic characteristics. Methods We retrospectively reviewed 46 patients with grade 1 and 2 chondrosarcomas. There were 25 men and 21 women with a mean age of 43 years (range, 17-79 years). Minimum followup was 32 months (mean, 99 months; range, 32-312 months) for the patients who remained alive in the end of the study. Twenty-three of the tumors were intracompartmental (Enneking A); of these, 19 were Grade 1 and 4 were Grade 2. Twenty-three tumors were extracompartmental (Enneking B); of these, 4 were Grade 1 and 19 were Grade 2. Twenty-five patients underwent intralesional resection, 18 had wide resection, and three had amputations. Results The overall survival rate was 94% and the disease-free survival rate was 90%.
International Journal of Surgery: Oncology, 2018
Importance: This review provides an in-depth discussion of the different treatment and management strategies adopted for chondrosarcoma, the various outcomes and the prognostic factors of the disease. Chondrosarcoma is the third most common malignant bone tumor after myeloma and osteosarcoma. It is characterized by the production of a cartilaginous matrix by malignant cells. It can be classified according to the source of its origin, histopathologic grade, site of occurrence, and rarity. Chondrosarcomas that are de novo in nature are classified as primary chondrosarcomas, while those derived from pre-existing enchondromas or osteochondromas are regarded as secondary chondrosarcomas. Other rare forms of chondrosarcoma include dedifferentiated, mesenchymal, and clear cell chondrosarcomas. Observations/Findings: Early diagnosis, accurate interpretation of histopathology, precise grading, and careful localization are crucial in the management of chondrosarcoma. Surgery is the treatment of choice. Three forms of surgical interventions are present; curettage, radical resection, and amputation. The choice of procedure depends on the size and site of the lesion and degree of malignancy. Radical procedures give the most promising outcomes with wider margins yielding better prognosis. Recurrence is usually seen with delayed surgery, high histopathologic grading, inadequate surgical procedures, marginal excision or curettage, tumor present in inaccessible sites such as sacrum and metastasis. Conclusion: Chondrosarcoma is responsible for placing a significant burden on pediatric as well as adult orthopedic oncology. Optimum diagnosis, accurate interpretation of histopathology, precise grading, careful localization, and timely as well as adequate management is crucial to successfully manage and prevent recurrence of the disease. Surgery is the most effective form of treatment. The main goal of treatment and management is to keep well ahead of the growth of the neoplasm and to prevent recurrences.
Low-Grade Chondrosarcomas: Diagnosis and Treatment
2021
Background: Multiple parameters are needed to distinguish between enchondroma and low-grade chondrosarcoma (LGCS). This study aimed to investigate the diagnosis, surgery type according to bone type, recurrence rates, and complications of LGCS in the appendicular and axial skeletons. Methods: A total of 52 surgically treated patients with LGCS, between March 2007 and May 2019, were retrospectively examined. Following diagnosis, the patients were operated on with intralesional curettage for long bones or wide local excision (WLE) for axial bones. The retrieved data included demographics, tumor location, surgical treatment type, local adjuvants, complications, and Musculoskeletal Tumor Society scores.Results: The final cohort included 52 patients (52 tumors; 35 female and 17 male). The male:female ratio was 1:2. The mean age was 44 ± 17 years. Forty of the tumors were treated with intralesional procedures (all with a high-speed burr and phenol), 6 with autograft, 8 with allograft, and ...
Extended Intralesional Treatment versus Resection of Low-grade Chondrosarcomas
Clinical Orthopaedics and Related Research®, 2009
The need for segmental resection versus intralesional treatment of low-grade chondrosarcomas of the appendicular skeleton remains controversial. We hypothesized extended intralesional treatment would equally control malignant disease but with improved functional outcomes and decreased postoperative complications. We retrospectively reviewed 31 patients with 32 Grade I intracompartmental chondrosarcomas of the long bones of the appendicular skeleton treated with either resection (15 lesions) or extended intralesional curetting (17) at a minimum followup of 2 years (median, 55 months; range, 24-203 months). Lesions were larger and median followup was longer in the resection cohort. One local recurrence developed in each treatment cohort and neither transitioned to a higher grade of tumor. No patient had metastases develop or died of disease. The mean final Musculoskeletal Tumor Society functional scores were greater after extended intralesional versus resection treatment (29.5 versus 25.
Archives of orthopaedic and trauma surgery, 2018
Chondroid lesions are very common bone tumors. In most cases, they are benign enchondromas (EC) and, in a minor percentage, chondrosarcomas (CSs), the malignant counterpart. In the latter cases, surgery is the mainstay treatment, because they are chemo- and radio-resistant unless dedifferentiation occurs. If resection is recognized as the gold standard for intermediate-, high-grade tumors, and for low-grade chondrosarcoma (LG-CS) located in the spine and pelvis to reduce the risk of local recurrence, there is still no consensus in literature on the treatment of central low-grade chondrosarcoma (cLG-CS) located in the limbs. Our aim is to perform a review of literature on evidence supporting this approach or not. An electronic research of the medical archives was carried out in March 2017 seeking papers evaluating the results of curettage and resection in cLG-CS. We selected 13 studies corresponding to our criteria. Unfortunately, they were descriptive, retrospective, non-randomized ...
Outcome of intralesional curettage for low-grade chondrosarcoma of long bones
European Journal of Surgical Oncology (EJSO), 2009
Background: Different treatment strategies for low-grade chondrosarcomas are reported in the literature with variable outcomes. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage and cementation of the lesion as a treatment strategy. Patients and methods: We performed a retrospective review of 39 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and cementation at our institution between 1999 and 2005. Results: There were 10 males and 29 females with a mean age of 55.5 years (32e82), and a mean follow-up of 5.1 years (3e8.7). Local recurrence occurred in two patients (5%) within the first two years following index surgery. Both were treated by re-curettage and cementation of the resultant defects. A second local recurrence developed a year later in one of these two patients, for which a further curettage followed by local liquid nitrogen treatment was performed. Overall, there were no cases of post-operative complications or metastases. The patients were assessed using the Musculoskeletal Tumour Society scoring system (MSTS) to determine limb function. The average score achieved was 94% (79e100%). Conclusion: Intralesional curettage is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones, with excellent oncological and functional results. Careful case selection with stringent clinical and radiographic follow-up is recommended. Please cite this article in press as: Hanna SA et al., Outcome of intralesional curettage for low-grade chondrosarcoma of long bones, Eur J Surg Oncol (2009),