Chondrosarcoma of the Chest Wall: A Review of 53 Cases from Two Institutions

Abstract

Background/Aim: Chondrosarcomas (CS) of the chest wall are rare, but present an aggressive biological behavior compared to CS of the extremities. The aims of the present study were to determine factors associated with oncological outcomes as well as complications. Patients and Methods: We retrospectively analyzed 53 patients (42 primary, 11 recurrent tumors). In total, 39 central CS, 10 peripheral CS, 3 dedifferentiated CS and 1 mesenchymal CS were included. The ribs were most commonly affected (68%). Overall survival and disease-free survival were estimated with Kaplan-Meier analyses and compared with log-rank test. Results: Mean follow-up was 7 years. Negative margins were achieved in 87% of patients. Thirty patients (57%) remained continuously disease-free (NED), three (5%) NED after treatment of relapse, seven (13%) were alive with disease, twelve (23%) were dead with disease and one of other cause. The 10-year survival rate was 81% and 45% in primary and recurrent tumors, respectively. Survival was significantly affected by tumor stage (p<0.001), local recurrence (p=0.025) and metastases (p=0.002). Six complications (16%) were observed. Conclusion: The outcome is rather poor, especially in patients with local recurrence. Presumably due to a high biological aggressiveness, a stricter definition of surgical margins should be considered for this location.Chondrosarcomas account for about 20% of all primary malignant osseous tumors, representing the third most common primary malignancy of bone after myeloma and osteosarcoma (1, 2). They are most frequently located in the pelvis (ilium), followed by proximal femur, proximal humerus and distal femur (3, 4). The chest wall (primarily the ribs) is affected in about 15% of cases, and thus the annual incidence is extremely low for this manifestation site (5, 6). However, chondrosarcoma represents the most common primary bone tumor involving the ribs and sternum (7). Tumor-related factors, such as tumor grade and localization, have been shown to be independent predictors of chondrosarcoma patient survival (3). The rate of metastases has been also found higher in pelvic and chest wall chondrosarcomas, compared to conventional chondrosarcomas of the extremities (8). Thus, involvement of pelvis and chest wall have been associated with a poorer outcome. Particular characteristics of chest wall chondrosarcoma, like its close proximity to vital organs, its indolent nature, and the high risk of local recurrence have been further emphasized (5,8,9).Published studies on the outcome and prognostic factors of the patients with chondrosarcomas of the chest wall are relatively limited (5-15). Therefore, we performed this study to evaluate the distribution patterns, natural history and tumor-related data of patients with chondrosarcoma of the chest wall, and analyze patients' outcome with respect to survival and complications after surgical treatment. Patients and MethodsWe retrospectively studied all patients with histologically documented chondrosarcomas of the chest wall (sternum...

Chondrosarcoma of the Chest Wall

“…The ribs are thought to be more frequently affected than the sternum, which was also confirmed in our study, as only 12% of the cases were located in sternum 18,21,22 . In accordance with the literature, our results revealed that 60% of the tumors in the ribs were actually locating in the costochondral arches of the sternum 23 .…”

Multiple local recurrences of primary sternal chondrosarcoma: tumor manipulation or self-seeding

“…Beside that, the seeding of local tissue during resection is theoretically possible. After all, Local recurrence decrease survival rates to 45% at 5 and 10 years compared to 89% and 81% at 5 and 10 years in patients without recurrence [12].…”

“…Rascoe et al, reported a local recurrence in 50% of widely excised chondrosarcoma [ 6 ]. In addition to Lenze et al who found that 50% of locally recurrent chondrosarcoma had a clear resection margins [ 12 ]. Moreover, local recurrence increased the risk of distant metastasis ( p = 0.004) [ 5 ].…”

“…After all, Local recurrence decrease survival rates to 45% at 5 and 10 years compared to 89% and 81% at 5 and 10 years in patients without recurrence [ 12 ].…”

Challenging Surgery of a Large Chest Wall Chondrosarcoma - A Case Report

“…Since chest wall reconstruction procedures are developed, wider chest wall resection becomes possible [9]. In this case, the total resection of the costal margin and the six lower ribs didn't offer support of equipment for ribs reconstruction.…”