Experience in the treatment of dedifferentiated chondrosarcoma

Mitchell, A. D.; Ayoub, K.; Mangham, D. C.; Grimer, R. J.; Carter, S. R.; Tillman, R. M.

doi:10.1302/0301-620x.82b1.0820055

Cited by 87 publications

(103 citation statements)

References 4 publications

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“…Several preclinical efforts are currently underway to develop targeted therapy for dedifferentiated chondrosarcoma based on molecular approaches [14,15,17]. The low survival rates of patients we observed with dedifferentiated chondrosarcoma are comparable to those reported in previous studies (Table 3) [3,5,9,10,13,18,21,22]. This indicates the need for more systemic options.…”

Section: Discussionsupporting

confidence: 83%

“…Studies performed to date have not identified efficacious chemotherapy agents [3,5,9,10,13,18,21,22]. We therefore sought to determine diseasespecific survivorship (as well as local recurrences and metastases), prognostic variables associated with patient survival, and toxicities associated with ifosfamide-based chemotherapy for patients diagnosed with dedifferentiated chondrosarcoma.…”

Section: Discussionmentioning

confidence: 99%

“…This is likely the result of the small number of patients in our study. Studies performed to date have not shown a significant prognostic impact of adjuvant chemotherapy in patients with dedifferentiated chondrosarcoma [3,5,9,10,13,18,21,22]. Ifosfamide has been identified as one of the active drugs for bone and soft tissue sarcomas and was incorporated into chemotherapeutic regimens for osteosarcoma in the 1980s [6,11,19].…”

Section: Discussionmentioning

confidence: 99%

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Does Ifosfamide Therapy Improve Survival of Patients With Dedifferentiated Chondrosarcoma?

Kawaguchi

Sun²,

Lin

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Dedifferentiated chondrosarcoma remains a significant therapeutic challenge. Studies performed to date have not identified efficacious chemotherapy regimens for this disease. Questions/purposes We sought to (1) evaluate the disease-specific survival at 2 and 5 years of patients with dedifferentiated chondrosarcoma; (2) assess the prognostic variables (both patient-and treatment-related), including the use of chemotherapy with ifosfamide, that relate to survivorship; and (3) assess specific toxicities associated with ifosfamide use. Methods Data from 41 patients with dedifferentiated chondrosarcoma diagnosed and treated at the University of Texas MD Anderson Cancer Center from 1986 to 2010 were analyzed for demographics, treatments, oncologic outcomes, and prognostic variables. There were 14 women and 27 men. The mean age at diagnosis was 58 years (range, 26-86 years). Seven patients presented with metastasis. Surgical resection alone was performed in 11 patients; resection and chemotherapy in 26 patients; resection and radiotherapy in two patients; and resection, chemotherapy, and radiotherapy in two patients. Ifosfamide-based regimens were used for 16 patients. In general, ifosfamide was used when the tumor was located in the trunk or if cisplatin was discontinued as a result of toxicity. Minimum followup was 8 months (median, 68 months; range, 8-281 months). Survival was estimated using Kaplan-Meier plots and analyzed by using the Cox proportional hazards model. Results Disease-specific survival rates at 2 and 5 years were 33% and 15%, respectively. Multivariate analysis revealed that treatment without ifosfamide-based chemotherapy was the only independent negative prognostic factor for disease-specific survival (hazard ratio, 0.4; 95% confidence interval, 0.17-0.92; p = 0.03). Ifosfamide was discontinued in a patient as a result of renal dysfunction and was decreased in dose in another patient who developed encephalopathy. Conclusions In this small retrospective study, it appeared that ifosfamide-based adjuvant chemotherapy combined with surgical resection offered a treatment advantage compared with patients who did not receive the drug in Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does Ifosfamide Therapy Improve Survival of Patients With Dedifferentiated Chondrosarcoma?

Kawaguchi

Sun²,

Lin

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…One study seemed to show an effect on survival [77], which was not confirmed by others [37,78,79]. For peripheral dedifferentiated chondrosarcoma, arising in osteochondroma, chemotherapy led to longer survival in a small retrospective report [80].…”

Section: Systemic Treatmentmentioning

confidence: 91%

The Clinical Approach Towards Chondrosarcoma

et al. 2008

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After completing this course, the reader will be able to:1. Classify the chondrosarcoma subtypes.2. Engage in the diagnostic process of chondrosarcoma.3. Evaluate the treatment options for chondrosarcoma.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThis review provides an overview of the histopathology, classification, diagnostic procedures, and therapy of skeletal chondrosarcoma. Chondrosarcomas that arise de novo are primary chondrosarcomas, whereas chondrosarcomas developing superimposed on pre-existing benign cartilage neoplasms such as enchondromas or osteochondromas are referred to as secondary chondrosarcomas. Conventional chondrosarcomas can be categorized according to their location in bone into central, peripheral, and juxtacortical chondrosarcomas. Histological grading is related to prognosis; however, it is also subject to interobserver variability. Rare subtypes of chondrosarcoma, including dedifferentiated, mesenchymal, and clear cell chondrosarcoma, are discussed as well. Magnetic resonance imaging is necessary to delineate the extent of the intraosseous and soft tissue involvement preoperatively. Computed tomography is especially recommended in the pelvis and other flat bones where it may be difficult to discern the pattern of bone destruction and the presence of matrix mineralization. Wide, en-bloc excision is the preferred surgical treatment in intermediate-and high-grade chondrosarcoma. In low-grade chondrosarcoma confined to the bone, extensive intralesional curettage followed by local adjuvant treatment and filling the cavity with bone graft has promising long-term clinical results and satisfactory local control. Chondrosarcomas are relatively radiotherapy resistant; therefore, doses >60 Gy are needed in attempts to achieve local control after incomplete resection. Irradiation with protons or other charged particles seems beneficial in this curative situation. Chemotherapy is only possibly effective in mesenchymal chondrosarcoma, and is of uncertain value in dedifferentiated chondrosarcoma. Potential new systemic treatment targets are being discussed. The Oncologist 2008;13:320 -329

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“…Because the diagnoses were variable, expected survival would be guided by histopathologic diagnoses and stage at presentation. Despite the particularly poor prognosis associated with dedifferentiated chondrosarcomas [4,9,13,23], two of the three patients with this diagnosis were alive without disease. Although a somewhat surprising finding, long-term followup would be necessary to make additional comment on survival impact in this series.…”

Section: Discussionmentioning

confidence: 97%