Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function

Abstract

Background Chondrosarcomas of bone traditionally have been treated by wide or radical excision, procedures that may result in considerable lifelong disability. Grade 1 chondrosarcomas have little or no metastatic potential and are often difficult to distinguish from painful benign enchondromas. Curettage with adjuvant cryosurgery has been proposed as an alternative therapy for Grade 1 chondrosarcomas given the generally better function after the procedure. However, because it is an intralesional procedure, curettage and cryosurgery may be associated with higher rates of recurrence. Questions/purposes We asked whether Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery are associated with low recurrence rates and high functional scores. Patients and Methods We retrospectively reviewed the records of 46 patients with Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery. Forty-one patients had tumors of the long bones. Patients were followed a minimum of 18 months (average, 47.2. months; range, 18-134 months) for evidence of recurrence and for assessment of Musculoskeletal Tumor Society (MSTS) functional score.

Intralesional curettage of central low-grade chondrosarcoma: A midterm follow-up study

“…The MSTS score after curettage treatment was 99%, better than that in previous studies, which ranged from 90% to 93%. 7,16,21 Two cohort studies showed higher MSTS scores for patients who underwent intralesional curettage than those who underwent wide resection (98% vs. 84% and 89% vs.72%); 12,22 in our study, we had similar results with 99% vs. 94%. Additionally, the MSTS score was significantly different ( p ¼ 0.048) between the two groups.…”

“…Therefore, some studies are advocated using extended intralesional curettage, which was an option for benign aggressive tumors of bone, for patients with low-grade chondrosarcoma. 12e15 There are several adjuvant methods for extended intralesional curettage, such as phenol application, 13 cauterization, 12,15 or cryotherapy 16 followed by either cementation 17 or bone grafting. Previous studies have demonstrated that these adjuvant treatments are necessary for control of local recurrence.…”

Computed Tomography-Guided Core Needle Biopsy versus Incisional Biopsy in Diagnosing Musculoskeletal Lesions

“…10 In addition, we tried not to biopsy lesions that appeared to be low-grade lipomatous tumours, low-grade cartilaginous tumours, or myxoid, as they are difficult to interpret histologically. 3 Table 4 Accuracy of computed tomography-guided core needle biopsy (CT-guided CNB) and incisional biopsy for bone versus softtissue lesions Table 5 Accuracy of computed tomography-guided core needle biopsy (CT-guided CNB) and incisional biopsy in terms of lesion type lipomatous tumour, well-differentiated liposarcoma, or low-grade chondrosarcoma can be safely treated by marginal resection without biopsy 17,18 or extended intralesional curettage, 19,20 as the risk of recurrence is low. Nonetheless, in indeterminate lesions, biopsy is still recommended.…”

Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton

“…Nevertheless, local recurrence of grade 1 CS may present a progression of malignancy with an influence on patient survival [18]. In recent decades, intralesional curettage with local adjuvants and bone filling with either bone grafts or cement has been widely used as surgical treatment of grade 1 CS of the appendicular skeleton [12, 15–17, 19–22]. On the other hand, in case of an aggressive aspect on imaging and cortical disruption of grade 1 CS, resection with wide margins, following the surgical criteria of primary bone sarcoma, has been recommended [5, 6, 13, 14, 23, 24].…”