Intralesional treatment versus wide resection for central low-grade chondrosarcoma of the long bones

Dierselhuis, Edwin F; Goulding, Krista; Stevens, Martin; Jutte, Paul C.

doi:10.1002/14651858.cd010778.pub2

Cited by 30 publications

(53 citation statements)

References 60 publications

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“…[13][14][15] We found a recurrence-free survival of 97% which is in line with the literature (mean recurrence-free survival, 93%; range, 77%-100%). 6 Two cases initially diagnosed as ACT after biopsy and curettage and cryosurgery recurred with radiologic aggressive characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Grade 2 and Grade 3 chondrosarcoma behave aggressively and wide resection with free margins is mandatory 4 . Due to their slow growth and very low metastatic potential, atypical cartilaginous tumors (ACTs), formerly known as chondrosarcoma grade 1, are usually treated with intralesional surgery, because functional results are superior to wide resection 6 . Taken into account the behavior of ACTs and the difficulty in differentiating them from benign enchondromas, wide resection is considered disproportionate.…”

Section: Introductionmentioning

confidence: 99%

“…There is still controversy over the best surgical method in current literature. [6][7][8] In their systematic review, Dierselhuis et al 6 found evidence of very low certainty that recurrence-free survival is equal between intralesional treatment and wide resection. They stated that there was very limited and very lowcertainty evidence on how to treat central low-grade chondrosarcoma of the long bones.…”

mentioning

confidence: 99%

“…Local recurrence and complication rates vary widely, respectively, 0%-26.3% and 0%-21%. [6][7][8] In our orthopedic oncology center, we have been treating both enchondroma and ACT with curettage and cryosurgery since 1991. In this paper, we describe our oncological results and complications after curettage and cryosurgery of these tumors located in the long bones.…”

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confidence: 99%

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Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series

Deckers

Leijer

Flucke

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: Intralesional surgical treatment is the preferred therapy for atypical cartilaginous tumors (ACTs) of the long bones in many institutions. However, the literature is still controversial regarding intralesional treatment versus wide resection. Due to the relative rarity of these tumors, studies reporting on the results of intralesional treatment are often small sample studies. Methods: We retrospectively analyzed the oncological results of 55 enchondromas, 119 ACTs, and 5 chondrosarcomas grade 2 (CS2) treated with curettage and cryosurgery between the years 2004 and 2017 at our institution. The median follow-up period was 53 months (range, 24-169 months). Results: In total, seven cases (three ACT, four CS2) recurred. Residual tumor was detected in 20 cases. Three cases underwent secondary curettage and cryosurgery due to local recurrence. Four cases underwent wide resection and reconstruction due to local recurrence with aggressive imaging characteristics. In total, 20 postoperative complications were seen. Conclusion:Curettage and cryosurgery for enchondroma and ACT show very good oncological results with a low recurrence rate and acceptable complication rate.Curettage and cryosurgery is reliable as a surgical treatment for enchondroma and ACT. Further research should define the criteria for determining which specific cartilaginous tumors necessitate surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series

Deckers

Leijer

Flucke

et al. 2021

Journal of Surgical Oncology

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“…Over the past few years, intralesional procedures have been advocated more often in the literature than wide excision in the management of grade I chondrosarcoma 27 . Extended curettage followed by adjuvant treatments is currently a definitive treatment in many institutions as well as ours.…”

Section: Discussionmentioning

confidence: 99%

Quantitative SPECT/CT for differentiating between enchondroma and grade I chondrosarcoma

Choi

Han

Chang

et al. 2020

Sci Rep

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Although differentiation between central chondroid tumors is important, their parallelism makes it a diagnostic conundrum for clinicians and radiologists. The objective of this study was to evaluate the efficiency of quantitative single photon emission computed tomography (SPECT)/computed tomography (CT) in differentiating grade I chondrosarcomas from enchondromas. We reviewed SPECT/CT images of patients with enchondromas and grade I chondrosarcomas arising in the long bones. Volume, mean standardized uptake value (SUVmean), and maximum standardized uptake value (SUVmax) of tumors were calculated from SPECT/CT images. In addition, clinical characteristics and radiological information were assessed. Of a total of 34 patients, 14 had chondrosarcomas. Chondrosarcoma group had significantly larger volume, and higher SUVmean and SUVmax of tumors than enchondroma group. There was no significant difference in age and tumor size between two groups. Areas under the receiver-operating characteristic curve (AUCs) for tumor volume, SUVmean, and SUVmax were 0.727, 0.757, and 0.875. In pairwise analyses, SUVmax had larger AUC than SUVmean (p = 0.0216). With a cutoff value of 15.6 for SUVmax, its sensitivity and specificity were 86% and 75% for differentiating between enchondroma and grade I chondrosarcoma. Quantitative SPECT/ CT is a potential method to differentiate grade I chondroarcomas from enchondromas in patients with central chondroid tumors. Differentiation between central chondroid tumors is important because surgical treatment is the only curative management for patients with grade I chondrosarcoma. A wait-and-see policy is permissible for enchondromas in consideration of long-term prognosis 1,2. Nevertheless, their parallelism makes it a diagnostic conundrum for clinicians and radiologists to distinguish them 3. Clinical symptoms such as spontaneous pain are believed to be helpful in distinction. However, patients with enchondroma uncommonly complained of resting pain and the presentation without symptom does not rule out malignancy 4. Although poorly defined margin, deep endosteal scalloping, the size over 5 cm, periosteal reaction without a history of trauma, and epiphyseal location in plain radiography favor chondrosarcoma, the discriminating power of this set of parameters is limited 2,5. While chondrosarcomas with lobulated lesion, osseous destruction and fibrovascular septae on magnetic resonance imaging (MRI), and early enhancement pattern on dynamic contrast-enhanced (DCE) MRI can be used for differential diagnosis of chondroid tumors 6 , their usefulness remains controversial 5,7,8. Interpretation of radiological findings demonstrated low reliability for grading of cartilaginous tumors, even among expert radiologists 3. Diffusionweighted MRI and quantitative assessment by apparent diffusion coefficient values are expected to be attributed to more accurate and consistent diagnosis for that reason. However, the role of diffusion-weighted MRI is also questioned 3,9. Although F-18 fluorodeoxyglucose positron em...

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The value of chest and skeletal staging studies in conventional chondrosarcoma

et al. 2020

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Intralesional treatment versus wide resection for central low-grade chondrosarcoma of the long bones

Abstract: Intralesional treatment versus wide resection for central low-grade chondrosarcoma of the long bones.

Cited by 30 publications

References 60 publications

Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series

Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series

Quantitative SPECT/CT for differentiating between enchondroma and grade I chondrosarcoma

The value of chest and skeletal staging studies in conventional chondrosarcoma

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