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Does Ifosfamide Therapy Improve Survival of Patients With Dedifferentiated Chondrosarcoma?

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

Abstract

Background

Dedifferentiated chondrosarcoma remains a significant therapeutic challenge. Studies performed to date have not identified efficacious chemotherapy regimens for this disease.

Questions/purposes

We sought to (1) evaluate the disease-specific survival at 2 and 5 years of patients with dedifferentiated chondrosarcoma; (2) assess the prognostic variables (both patient- and treatment-related), including the use of chemotherapy with ifosfamide, that relate to survivorship; and (3) assess specific toxicities associated with ifosfamide use.

Methods

Data from 41 patients with dedifferentiated chondrosarcoma diagnosed and treated at the University of Texas MD Anderson Cancer Center from 1986 to 2010 were analyzed for demographics, treatments, oncologic outcomes, and prognostic variables. There were 14 women and 27 men. The mean age at diagnosis was 58 years (range, 26–86 years). Seven patients presented with metastasis. Surgical resection alone was performed in 11 patients; resection and chemotherapy in 26 patients; resection and radiotherapy in two patients; and resection, chemotherapy, and radiotherapy in two patients. Ifosfamide-based regimens were used for 16 patients. In general, ifosfamide was used when the tumor was located in the trunk or if cisplatin was discontinued as a result of toxicity. Minimum followup was 8 months (median, 68 months; range, 8–281 months). Survival was estimated using Kaplan-Meier plots and analyzed by using the Cox proportional hazards model.

Results

Disease-specific survival rates at 2 and 5 years were 33% and 15%, respectively. Multivariate analysis revealed that treatment without ifosfamide-based chemotherapy was the only independent negative prognostic factor for disease-specific survival (hazard ratio, 0.4; 95% confidence interval, 0.17–0.92; p = 0.03). Ifosfamide was discontinued in a patient as a result of renal dysfunction and was decreased in dose in another patient who developed encephalopathy.

Conclusions

In this small retrospective study, it appeared that ifosfamide-based adjuvant chemotherapy combined with surgical resection offered a treatment advantage compared with patients who did not receive the drug in patients with dedifferentiated chondrosarcoma, although disease-specific survival for patients who have this rare tumor remains dismal.

Level of Evidence

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

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Acknowledgments

We thank Ms Kim-Anh T. Vu for the illustration.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1448, Houston, TX, 77030, USA

    Satoshi Kawaguchi MD, Patrick P. Lin MD & Valerae O. Lewis MD

  2. Department of Orthopaedic Surgery, Shijiazhuang, China

    Tao Sun MD

  3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Michael Deavers MD

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Nusrat Harun PhD

Authors
  1. Satoshi Kawaguchi MD
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  2. Tao Sun MD
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  3. Patrick P. Lin MD
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  4. Michael Deavers MD
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  5. Nusrat Harun PhD
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  6. Valerae O. Lewis MD
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Corresponding author

Correspondence to Valerae O. Lewis MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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

This work was performed at the University of Texas MD Anderson Cancer Center, Houston, TX, USA.

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Kawaguchi, S., Sun, T., Lin, P.P. et al. Does Ifosfamide Therapy Improve Survival of Patients With Dedifferentiated Chondrosarcoma?. Clin Orthop Relat Res 472, 983–989 (2014). https://doi.org/10.1007/s11999-013-3360-5

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  • DOI: https://doi.org/10.1007/s11999-013-3360-5

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