Current Treatment Options in Oncology

, Volume 10, Issue 1–2, pp 94–106 | Cite as

The Clinical Management of Chondrosarcoma

  • Richard F. RiedelEmail author
  • Nicole Larrier
  • Leslie Dodd
  • David Kirsch
  • Salutario Martinez
  • Brian E. Brigman
Bone Cancer

Opinion statement

Chondrosarcomas (CHS) represent a heterogeneous group of disorders ranging from indolent, low-grade tumors to aggressive, high-grade forms. Surgical resection represents the primary and preferred treatment modality for individuals with localized disease. Radiation therapy is appropriate for the treatment of positive surgical margins or palliation of disease-related symptoms. The treatment of advanced, metastatic disease is particularly challenging given the recognition that conventional chemotherapy has proven to be largely ineffective. Systemic chemotherapy may be considered in variant forms such as mesenchymal or dedifferentiated chondrosarcomas but high-quality data supporting its use is limited. There is universal agreement, however, that novel treatment strategies are desperately needed. This review will highlight the need for a coordinated multidisciplinary approach to optimize the management and care of patients.


Standard Uptake Value National Comprehensive Cancer Network Radiat Oncol Biol Phys Chondrosarcoma National Comprehensive Cancer Network 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Cobalt gray equivalent




Computed tomography


Disease free survival




Fractionated stereotactic radiation therapy


Gray equivalent






Magnetic resonance


Magnetic resonance imaging


National comprehensive cancer network




Positron emission tomography


Radiation therapy


Standard uptake value


TNF-related apoptosis inducing ligand


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance • Of major importance

  1. 1.•
    Damron TA, Ward WG, Stewart A: Osteosarcoma, chondrosarcoma, and Ewing’s sarcoma: National Cancer Data Base Report. Clin Orthop Relat Res 2007, 459:40–7. doi: 10.1097/BLO.0b013e318059b8c9.

A descriptive summary of epidemiological and survival data for the single largest series of cases for each of the three most common sarcomas of bone.

  1. 2.
    Sopta J, Dordevic A, Tulic G, et al.: Dedifferentiated chondrosarcoma our clinico-pathological experience and dilemmas in 25 cases. J Cancer Res Clin Oncol 2008 134(2) 147–52.PubMedCrossRefGoogle Scholar
  2. 3.
    Mitchell AD, Ayoub K, Mangham DC, et al.: Experience in the treatment of dedifferentiated chondrosarcoma. J Bone Joint Surg Br 2000, 82(1): 55–61.PubMedCrossRefGoogle Scholar
  3. 4.
    Dickey ID, Rose PS, Fuchs B, et al.: Dedifferentiated chondrosarcoma: the role of chemotherapy with updated outcomes. J Bone Joint Surg Am 2004, 86-A(11): 2412–8.PubMedGoogle Scholar
  4. 5.
    Frassica FJ, Unni KK, Beabout JW, et al.: Dedifferentiated chondrosarcoma. A report of the clinicopathological features and treatment of seventy-eight cases. J Bone Joint Surg Am 1986, 68(8): 1197–205.PubMedGoogle Scholar
  5. 6.
    Bjornsson J, Unni KK, Dahlin DC, et al.: Clear cell chondrosarcoma of bone. Observations in 47 cases. Am J Surg Pathol 1984, 8(3): 223–30.PubMedCrossRefGoogle Scholar
  6. 7.
    Present D, Bacchini P, Pignatti G, et al.: Clear cell chondrosarcoma of bone. A report of 8 cases. Skeletal Radiol 1991, 20(3): 187–91.PubMedCrossRefGoogle Scholar
  7. 8.
    Ayoub KS, Grimer RJ, Carter SR, et al.: Clear cell chondrosarcoma of bone. Sarcoma 1999, 3(2): 115–9.PubMedCrossRefGoogle Scholar
  8. 9.
    Nakashima Y, Park YK, Sugano O: Mesenchymal chondrosarcoma. In World Health Organization Classification of Tumours: Pathology and Genetics. Tumours of Soft Tissue and Bone. Edited by Fletcher CDM, Unni KK, Mertens F. Lyon, France: IARC Press; 2002: 255–256.Google Scholar
  9. 10.
    Dantonello TM, Int-Veen C, Leuschner I, et al.: Mesenchymal chondrosarcoma of soft tissues and bone in children, adolescents, and young adults: experiences of the CWS and COSS study groups. Cancer 2008, 112(11): 2424–31.PubMedCrossRefGoogle Scholar
  10. 11.
    Guillou L, Coindre JM, Bonichon F, et al.: Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol 1997, 15(1): 350–62.PubMedGoogle Scholar
  11. 12.
    Feldman F, Van Heertum R, Saxena C, et al.: 18FDG-PET applications for cartilage neoplasms. Skeletal Radiol 2005, 34(7): 367–74.PubMedCrossRefGoogle Scholar
  12. 13.
    Brenner W, Conrad EU, Eary JF: FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients. Eur J Nucl Med Mol Imaging 2004, 31(2): 189–95.PubMedCrossRefGoogle Scholar
  13. 14.
    Geirnaerdt MJ, Hogendoorn PC, Bloem JL, et al.: Cartilaginous tumors: fast contrast-enhanced MR imaging. Radiology 2000, 214(2): 539–46.PubMedGoogle Scholar
  14. 15.
    Murphey MD, Walker EA, Wilson AJ, et al.: From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics 2003, 23(5): 1245–78.PubMedCrossRefGoogle Scholar
  15. 16.
    Skeletal Lesions Interobserver Correlation amon Expert Diagnosticians (SLICED) Study Group: Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am 2007, 89(10): 2113–23.CrossRefGoogle Scholar
  16. 17.
    Lee FY, Mankin HJ, Fondren G, et al.: Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am 1999, 81(3): 326–38.PubMedGoogle Scholar
  17. 18.
    Rizzo M, Ghert MA, Harrelson JM, et al. (2001) Chondrosarcoma of bone: analysis of 108 cases and evaluation for predictors of outcome. Clin Orthop Relat Res 391: 224–233.PubMedCrossRefGoogle Scholar
  18. 19.
    Fiorenza F, Abudu A, Grimer RJ, et al.: Risk factors for survival and local control in chondrosarcoma of bone. J Bone Joint Surg Br 2002, 84(1): 93–9.PubMedCrossRefGoogle Scholar
  19. 20.
    Bruns J, Elbracht M, Niggemeyer O: Chondrosarcoma of bone: an oncological and functional follow-up study. Ann Oncol 2001, 12(6): 859–64.PubMedCrossRefGoogle Scholar
  20. 21.
    Pring ME, Weber KL, Unni KK, et al.: Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg Am 2001, 83-A(11): 1630–42.PubMedGoogle Scholar
  21. 22.
    Donati D, El Ghoneimy A, Bertoni F, et al.: Surgical treatment and outcome of conventional pelvic chondrosarcoma. J Bone Joint Surg Br 2005, 87(11): 1527–30.PubMedCrossRefGoogle Scholar
  22. 23.
    Marco RA, Gitelis S, Brebach GT, et al.: Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg 2000, 8(5): 292–304.PubMedGoogle Scholar
  23. 24.
    Leerapun T, Hugate RR, Inwards CY, et al.: Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop Relat Res 2007, 463: 166–72.PubMedGoogle Scholar
  24. 25.
    Normand AN, Cannon CP, LewisVO, et al.: Curettage of biopsy-diagnosed grade 1 periacetabular chondrosarcoma. Clin Orthop Relat Res 2007, 459: 146–9.PubMedCrossRefGoogle Scholar
  25. 26.
    Van Der Geest IC, Servaes P, Schreuder HW, et al.: Chondrosarcoma of bone: functional outcome and quality of life. J Surg Oncol 2002; 81(2): 70–4.CrossRefGoogle Scholar
  26. 27.
    Schwab JH, Wenger D, Unni K, et al.: Does local recurrence impact survival in low-grade chondrosarcoma of the long bones? Clin Orthop Relat Res 2007, 462: 175–80.PubMedCrossRefGoogle Scholar
  27. 28.
    Noel G, Feuvret L, Ferrand R, et al.: Radiotherapeutic factors in the management of cervical-basal chordomas and chondrosarcomas. Neurosurgery 2004, 55(6): 1252–60; discussion 1260–2.PubMedGoogle Scholar
  28. 29.
    Munzenrider JE, Liebsch NJ: Proton therapy for tumors of the skull base. Strahlenther Onkol 1999, 175 Suppl 2: 57–63.PubMedCrossRefGoogle Scholar
  29. 30.
    Hug EB, Loredo LN, Slater JD, et al.: Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 1999, 91(3): 432–9.PubMedCrossRefGoogle Scholar
  30. 31.
    Weber DC, Rutz HP, Pedroni ES, et al.: Results of spot-scanning proton radiation therapy for chordoma and chondrosarcoma of the skull base: the Paul Scherrer Institut experience. Int J Radiat Oncol Biol Phys 2005, 63(2): 401–9.PubMedGoogle Scholar
  31. 32.
    Castro JR, Linstadt DE, Bahary JP, et al.: Experience in charged particle irradiation of tumors of the skull base: 1977–1992. Int J Radiat Oncol Biol Phys 1994, 29(4): 647–55.PubMedGoogle Scholar
  32. 33.
    Schulz-Ertner D, Nikoghosyan A, Hof H, et al.: Carbon ion radiotherapy of skull base chondrosarcomas. Int J Radiat Oncol Biol Phys 2007, 67(1): 171–7.PubMedGoogle Scholar
  33. 34.
    Debus J, Schulz-Ertner D, Schad L, et al.: Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys 2000, 47(3): 591–6.PubMedCrossRefGoogle Scholar
  34. 35.
    Delaney TF, Liebsch NJ, Pedlow FX, et al.: Phase II study of high-dose photon/proton radiotherapy in the management of spine sarcomas. Int J Radiat Oncol Biol Phys 2008 (Epub ahead of print).Google Scholar
  35. 36.
    Grimer RJ, Gosheger G, Taminiau A, et al.: Dedifferentiated chondrosarcoma: prognostic factors and outcome from a European group. Eur J Cancer 2007, 3(14): 2060–5.CrossRefGoogle Scholar
  36. 37.••
    Biermann JS, Adkins D, Benjamin R, et al.: Bone cancer. J Natl Compr Canc Netw 2007, 5(4):420–437.Google Scholar

NCCN consensus guidelines for the management of patients with bone cancers, including chondrosarcomas.

  1. 38.
    Cesari M, Bertoni F, Bacchini P, et al.: Mesenchymal chondrosarcoma. An analysis of patients treated at a single institution. Tumori 2007, 93(5): 423–7.PubMedGoogle Scholar
  2. 39.

Copyright information

© Current Medicine Group LLC 2009

Authors and Affiliations

  • Richard F. Riedel
    • 1
    Email author
  • Nicole Larrier
    • 2
  • Leslie Dodd
    • 3
  • David Kirsch
    • 2
  • Salutario Martinez
    • 4
  • Brian E. Brigman
    • 5
  1. 1.Division of Medical Oncology, Department of Internal MedicineDuke University Medical CenterDurhamUSA
  2. 2.Department of Radiation OncologyDuke University Medical CenterDurhamUSA
  3. 3.Department of PathologyDuke University Medical CenterDurhamUSA
  4. 4.Department of RadiologyDuke University Medical CenterDurhamUSA
  5. 5.Division of Orthopaedic Surgery, Department of SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations