Abstract
Background
Wide excision is considered the standard treatment for high-grade chondrosarcoma, but little is known regarding the effect of curettage on patient outcome in grade 2 chondrosarcoma.
Methods
The records of 32 patients with nonmetastatic grade 2 central chondrosarcoma of the appendicular skeleton were analyzed. The clinical characteristics and outcomes of 15 patients who underwent curettage (the case group) followed by subsequent treatment and 17 patients who underwent standard treatment were compared. The mean follow-up period for all 32 patients was 110 months (range, 31–230 months).
Results
Cases had a smaller tumor volume at presentation (P = .02), a lower Enneking’s stage IIA (P < .01), a lower rate of biopsy (P < .01), and a lower incidence of chondroid calcification by plain radiography (P < .01) than controls. Of the 32 study subjects, 2 (1 in the each group) developed local recurrence. The 10-year overall and metastasis-free survival rates for all 32 chondrosarcomas were 84.6% ± 14.5% and 70.3% ± 16.5%, respectively. Event-free survivals were similar for cases and controls (P = .16).
Conclusions
Intracompartmental grade 2 chondrosarcoma with nonaggressive radiologic pattern have a chance of curettage. However, proper subsequent management achieves outcomes comparable with those of primary wide excision.
Similar content being viewed by others
References
Dahlin DC, Henderson ED (1956) Chondrosarcoma, a surgical and pathological problem; review of 212 cases. J Bone Joint Surg Am 38-A:1025–38.
Giuffrida AY, Burgueno JE, Koniaris LG, Gutierrez JC, Duncan R, Scully SP. Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Joint Surg Am. 2009;91:1063–72.
Evans HL, Ayala AG, Romsdahl MM. Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer. 1977;40:818–31.
Fiorenza F, Abudu A, Grimer RJ, Carter SR, Tillman RM, Ayoub K, et al. Risk factors for survival and local control in chondrosarcoma of bone. J Bone Joint Surg Br. 2002;84:93–9.
Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, et al. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999;81:326–38.
Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F. Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res. 2010;468:581–9.
Healey JH, Lane JM. Chondrosarcoma. Clin Orthop Relat Res. 1986;204:119–29.
Leerapun T, Hugate RR, Inwards CY, Scully SP, Sim FH. Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop Relat Res. 2007;463:166–72.
Mohler DG, Chiu R, McCall DA, Avedian RS. Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function. Clin Orthop Relat Res. 2010;468:2765–73.
Schreuder HW, Pruszczynski M, Veth RP, Lemmens JA. Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery. Eur J Surg Oncol. 1998;24:120–6.
Souna BS, Belot N, Duval H, Langlais F, Thomazeau H. No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop Relat Res. 2010;468:1956–62.
Skeletal Lesions Interobserver Correlation among Expert Diagnosticians (SLICED) Study Group. Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am. 2007;89:2113–23.
Eefting D, Schrage YM, Geirnaerdt MJ, Le Cessie S, Taminiau AH, Bovee JV, et al. Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol. 2009;33:50–7.
Marco RA, Gitelis S, Brebach GT, Healey JH. Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg. 2000;8:292–304.
Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–20.
Ayerza MA, Muscolo DL, Aponte-Tinao LA, Farfalli G. Effect of erroneous surgical procedures on recurrence and survival rates for patients with osteosarcoma. Clin Orthop Relat Res. 2006;452:231–5.
Kim MS, Lee SY, Cho WH, Song WS, Koh JS, Lee JA, et al. Prognostic effects of doctor-associated diagnostic delays in osteosarcoma. Arch Orthop Trauma Surg. 2009;129:1421–5.
Marcove RC, Stovell PB, Huvos AG, Bullough PG. The use of cryosurgery in the treatment of low and medium grade chondrosarcoma. A preliminary report. Clin Orthop Relat Res. 1977;122:147–56.
de Camargo OP, Baptista AM, Atanasio MJ, Waisberg DR. Chondrosarcoma of bone: lessons from 46 operated cases in a single institution. Clin Orthop Relat Res. 2010;468:2969–75.
Rosenthal DI, Schiller AL, Mankin HJ. Chondrosarcoma: correlation of radiological and histological grade. Radiology. 1984;150:21–6.
Bjornsson J, McLeod RA, Unni KK, Ilstrup DM, Pritchard DJ. Primary chondrosarcoma of long bones and limb girdles. Cancer. 1998;83:2105–19.
Acknowledgment
This study was supported by a grant of the KCCH research competence promotion program (50246-2010).
Conflict of interest
The authors certify that they have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might constitute a conflict of interest in connection with the submitted article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cho, W.H., Song, W.S., Jeon, DG. et al. Oncologic Impact of the Curettage of Grade 2 Central Chondrosarcoma of the Extremity. Ann Surg Oncol 18, 3755–3761 (2011). https://doi.org/10.1245/s10434-011-1792-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-1792-2