Outcome of intralesional curettage for low-grade chondrosarcoma of long bones
Introduction
Chondrosarcoma is the second most commonly occurring primary malignant bone tumour, with a peak incidence between the fourth and seventh decades of life.1, 2, 3, 4, 5 These tumours were first described as a separate entity by Phemister in 1930.6 In adults, the pelvis, ribs, shoulder girdle, femur, and humerus are mainly affected, while in children, facial bones and the knee region are the main sites.7 The majority of lesions arise centrally in normal bone, uncommonly in pre-existing benign cartilaginous tumours (secondary chondrosarcoma), and rarely in synovial chondromatosis or ‘de novo’ in the synovium.1, 8, 9 They have a variable and often unpredictable outcome, ranging from slowly growing indolent lesions, to highly aggressive invasive sarcomas.10 Authors link the prognosis to tumour size, anatomical location, and most importantly, histological grade.10, 11 Five to 10 year survival rates for patients with low-grade tumours range from 85% to 100%, and from 20% to 40% for high-grade tumours.10, 11, 12, 13, 14, 15, 16, 17 The treatment of chondrosarcoma is primarily surgical because of its resistance to chemotherapy and irradiation,1, 16, 18, 19 and while there is a universal acceptance that high-grade lesions in the appendicular skeleton are best treated by wide surgical resection, the diagnosis and management of low-grade lesions remains a controversial issue.19 Firstly, distinguishing intramedullary low-grade chondrosarcoma from enchondroma is difficult, particularly on needle core biopsy because of potential sampling issues.20 Secondly, there is currently no consensus with respect to the optimal surgical treatment for these cases. Different methods reported in the literature include wide excision, marginal excision, and intralesional curettage. Some authors advocate wide excision, necessitating substantial reconstructive surgery, often requiring massive endoprostheses or allografts.21, 22 In contrast, many others believe that less extensive surgery is indicated for less aggressive lesions.5, 13, 19, 23, 24, 25 This would minimises the need for complex limb reconstruction and results in a good functional outcome. In this paper, we examine the oncological and functional outcomes of intralesional curettage and cementation as a treatment strategy.
Section snippets
Patients and methods
Between 1999 and 2005, 39 consecutive patients with histologically verified low-grade intramedullary chondrosarcoma of long bones underwent intralesional curettage and cementation of their lesion at our institution. These patients were identified using our department's histopathology database and then were retrospectively reviewed. The inclusion criteria included a definitive histological diagnosis of grade 0.5 or 1 chondrosarcoma, intramedullary lesions arising in long bones, and a minimum
Oncological outcome
One patient died at 3.5 years post-operatively of an unrelated cause (myocardial infarction). She had had a grade 1 tumour in her left proximal humerus. At her last follow-up (3 years), she was completely pain-free and had excellent shoulder function. No signs of recurrence were noted on plain radiography at the time of review. Two of the 39 patients (5%) developed local recurrence within the first two years following index surgery. The first patient was a 60-year-old female with an original
Discussion
There is currently no universally accepted operative treatment for low-grade chondrosarcoma of long bones. Intralesional curettage, either alone or combined with local adjuvant treatments, marginal resection, and en bloc resection with biologic or endoprosthetic reconstruction are all described in the literature.5, 13, 19, 21, 22, 23, 24, 25
In contrast, high-grade chondrosarcoma is almost always treated with wide excision achieved by either amputation, or resection of the tumour with limb
Conclusion
This study supports the view that intralesional curettage is an effective treatment strategy for low-grade chondrosarcoma of long bones, with excellent oncological and functional results. We propose that this treatment option is a rational alternative to more radical procedures, as it preserves function, has low morbidity, is cost effective, and does not appear to have an adverse effect on long-term outcome. Careful patient selection with stringent clinical and radiographic follow-up is crucial
Conflict of interest
The authors declare that they have no conflict of interest.
References (35)
- et al.
Malignant bone tumour other than osteosarcoma and Ewing's sarcoma. Oxford text book of oncology
(1995) - et al.
Chondrosarcoma, a surgical and pathological problem; review of 212 cases
J Bone Joint Surg Am
(1956) - et al.
Chondrosarcoma
Clin Orthop Relat Res
(1986) Bone tumours: general aspects and data on 11,087 cases. Dahlin's bone tumours
(1996)- et al.
Surgical management of conventional grade I chondrosarcoma of long bones
Clin Orthop Relat Res
(2007) Chondrosarcoma of bone
Surg Gynecol Obstet
(1930)- et al.
Chondrosarcoma in the young. A clinicopathologic analysis of 79 patients younger than 21 years of age
Am J Surg Pathol
(1987 Dec) - et al.
Myxoid chondrosarcoma of the synovial tissue. A clinicopathologic, histochemical, and ultrastructural analysis
Cancer
(1983 Nov 15) - et al.
Chondrosarcomas of the synovium
Cancer
(1991 Jan 1) - et al.
A review of the behaviour of chondrosarcoma of bone
J Bone Joint Surg Br
(1979)
Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading
Cancer
Risk factors for survival and local control in chondrosarcoma of bone
J Bone Joint Surg Br
Low risk of recurrence of enchondromas and low-grade chondrosarcoma in extremities: 80 patients followed for 2–25 years
Acta Orthop Scand
Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas: a centre based study of 69 cases
Cancer
Surgical treatment and outcome of conventional pelvic chondrosarcoma
J Bone Joint Surg Br
Chondrosarcoma of bone: an assessment of outcome
J Bone Joint Surg Am
Chondrosarcoma of bone: oncological and functional results
J Surg Oncol
Cited by (51)
Long-term follow up of patients with low-grade chondrosarcoma in the appendicular skeleton treated by extended curettage and liquid nitrogen
2023, Orthopaedics and Traumatology: Surgery and ResearchThe role of surgical margins in chondrosarcoma
2018, European Journal of Surgical OncologyIs intralesional resection suitable for central grade 1 chondrosarcoma: A systematic review and updated meta-analysis
2017, European Journal of Surgical OncologyCitation Excerpt :More studies are needed to explore the exact indications for these two surgical techniques. Adjuvant therapies after intralesional resection were reported to achieve local tumor control32–34 and were recommended in the treatment of grade 1 chondrosarcoma to minimize local recurrence while preserving function.3,13–17 Adjuvant therapies adopted varied: phenol, cryosurgery, and cauterization with polymethyl methacrylate (PMMA) packing are among the most common adjuvant therapies for chondrosarcoma after intralesional resection.4,13,19,21,25,26,28,35,36
Proximal humerus chondrosarcoma.Long-term clinical and oncological outcomes
2019, Revista Espanola de Cirugia Ortopedica y Traumatologia