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Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Chondrosarcomas of bone traditionally have been treated by wide or radical excision, procedures that may result in considerable lifelong disability. Grade 1 chondrosarcomas have little or no metastatic potential and are often difficult to distinguish from painful benign enchondromas. Curettage with adjuvant cryosurgery has been proposed as an alternative therapy for Grade 1 chondrosarcomas given the generally better function after the procedure. However, because it is an intralesional procedure, curettage and cryosurgery may be associated with higher rates of recurrence.

Questions/purposes

We asked whether Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery are associated with low recurrence rates and high functional scores.

Patients and Methods

We retrospectively reviewed the records of 46 patients with Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery. Forty-one patients had tumors of the long bones. Patients were followed a minimum of 18 months (average, 47.2. months; range, 18–134 months) for evidence of recurrence and for assessment of Musculoskeletal Tumor Society (MSTS) functional score.

Results

Two of the 46 patients had recurrences in the original tumor site (4.3% recurrence rate), which subsequently were removed by wide excision, and both patients were confirmed to be disease-free 36 and 30 months, respectively, after the second surgery. The mean MSTS score was 27.2 of 30 points (median, 29 points).

Conclusions

Our observations show curettage with cryosurgery is associated with low recurrence of Grade 1 chondrosarcoma and high functional scores. Curettage with cryosurgery is a reasonable alternative to wide or radical excision as the treatment for Grade 1 chondrosarcomas, and allows for more radical surgery in the event of local recurrence.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Sandeep Biswal MD, Christopher Beaulieu MD, and Kathryn Stevens MD, for radiographic evaluation, and Matt van de Rijn MD, Jesse McKinney MD, and Richard Kempton MD, for pathologic evaluation of the patients in this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, M/C 6342, Redwood City, CA, 94063, USA

    David G. Mohler MD, Richard Chiu MS, David A. McCall MD & Raffi S. Avedian MD

Authors
  1. David G. Mohler MD
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  2. Richard Chiu MS
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  3. David A. McCall MD
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  4. Raffi S. Avedian MD
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Corresponding author

Correspondence to Richard Chiu MS.

Additional information

One of the authors (RC) has received research funding from the Stanford Medical Scholars Research Fellowship Program.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Mohler, D.G., Chiu, R., McCall, D.A. et al. Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function. Clin Orthop Relat Res 468, 2765–2773 (2010). https://doi.org/10.1007/s11999-010-1445-y

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  • DOI: https://doi.org/10.1007/s11999-010-1445-y

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