Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton

Abstract

BackgroundDiagnosis and treatment of low-grade chondrosarcoma remain controversial. We performed a review of a single-center series with the aims of assessing the oncologic outcome of these patients, verifying if intralesional curettage can be adequate treatment, and defining clinical criteria to support the surgeon and the oncologist in decision-making for surgery and subsequent follow-up.Materials and methodsA retrospective review of 85 patients was performed (61 females and 24 males, age range 20–76 years). The site of the lesion was the femur in 35 cases, humerus in 33, tibia in 15, and fibula in 2. Sixty-four patients were treated by intralesional curettage. Twenty-one patients with aggressive radiological patterns were treated with wide resection.ResultsMean follow-up was 67 months (range 24–206 months). Two patients developed local recurrence, both after intralesional curettage. The difference in incidence of recurrence was not statistically significant between the two groups. No distant metastases were observed. Postsurgical complications were significantly higher in the resection group.ConclusionsLow-grade chondrosarcoma of the appendicular skeleton without aggressive radiological patterns can be treated with intralesional surgery with good oncological outcome and very low rate of postsurgical complications. Wide resection, following surgical principles of malignant bone tumors, should be considered only when aggressive biologic behavior is evident on imaging.

Survival and prognostic factors in conventional central chondrosarcoma

“…The published data on G1 chondrosarcoma is conflicting. From 0% LR and MD [18, 19], 2% LR and 0% MD [20], 3% LR and 3% MD [21], 4% LR and 0% MD [22], 5% LR and 0% MD [23], 6% LR and 0% MD [24, 25], 9% LR and 0% MD [26], 11% LR and 3% MD [27], 13% LR and 4% MD [28], 13% LR and 5% MD [29] to 18% LR and 6% MD [7] a variety of different results are reported. 5-year survival ranges from 82 to 99% and 10-year survival from 89 to 95% [8].…”

Radiologic differentiation of enchondromas, atypical cartilaginous tumors, and high‐grade chondrosarcomas—Improving tumor‐specific treatment: A paradigm in transit?

“…29,30 PET-CT is more accurate in differentiating between an ACT and a CS: when the maximum standardized uptake value exceeds 4.4, a highgrade CS is very likely. 31,32 The histological grade should be correlated with the clinical presentation and imaging features. 31,32 The histological grade should be correlated with the clinical presentation and imaging features.…”

“…30 Although the reliability of biopsy is lower in comparison with other sarcomas, image-guided needle biopsy, when performed by a specialist radiologist and evaluated by an experienced bone pathologist, may help in determining the histological grade of CSs. 31,32 The histological grade should be correlated with the clinical presentation and imaging features. This combined multidisciplinary approach, using all available diagnostic criteria, could optimize surgical treatment planning.…”

Osteosarkomatös dedifferenziertes Chondrosarkom

“…In den letzten Jahren hat sich gezeigt, dass hochdifferenzierte zentrale Chondrosarkome der Extremitäten intraläsional therapiert werden können, ohne die Prognose negativ zu beeinflussen [4,9,12]. Das trifft nicht für Chondrosarkome des Stammskeletts, unabhängig vom Grading, zu.…”