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Laitinen MK, Parry MC, Le Nail LR, Wigley CH, Stevenson JD, Jeys LM. Locally recurrent chondrosarcoma of the pelvis and limbs can only be controlled by wide local excision. Bone Joint J 2019; 101-B:266-271. [DOI: 10.1302/0301-620x.101b3.bjj-2018-0881.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Aims The purpose of this study was to investigate the potential for achieving local and systemic control after local recurrence of a chondrosarcoma of bone Patients and Methods A total of 126 patients with local recurrence (LR) of chondrosarcoma (CS) of the pelvis or a limb bone were identified from a prospectively maintained database, between 1990 and 2015 at the Royal Orthopaedic Hospital, Birmingham, United Kingdom. There were 44 female patients (35%) and 82 male patients (65%) with a mean age at the time of LR of 56 years (13 to 96). The 126 patients represented 24.3% of the total number of patients with a primary CS (519) who had been treated during this period. Clinical data collected at the time of primary tumour and LR included the site (appendicular, extremity, or pelvis); primary and LR tumour size (in centimetres); type of operation at the time of primary or LR (limb-salvage or amputation); surgical margin achieved at resection of the primary tumour and the LR; grade of the primary tumour and the LR; gender; age; and oncological outcomes, including local recurrence-free survival and disease-specific survival. A minimum two years’ follow-up and complete histopathology records were available for all patients included in the study. Results For patients without metastases prior to or at the time of local recurrence, the disease-specific survival after local recurrence was 62.5% and 45.5% at one and five years, respectively. After univariable analysis, significant factors predicting disease-specific survival were grade (p < 0.001) and surgical margin (p = 0.044). After multivariable analysis, grade, increasing age at the time of diagnosis of local recurrence, and a greater time interval from primary surgery to local recurrence were significant factors for disease-specific survival. A secondary local recurrence was seen in 26% of patients. Wide margins were a good predictor of local recurrence-free survival for subsequent recurrences after univariable analysis when compared with intralesional margins (p = 0.002) but marginal margins did not reach statistical significance when compared with intralesional margins (p = 0.084) Conclusion In cases of local recurrence of a chondrosarcoma of bone, we have shown that if the tumour is non-metastatic at re-staging, an increase in disease-specific survival and in local recurrence-free survival is achievable, but only by resection of the local recurrence with a wide margin. Cite this article: Bone Joint J 2019;101-B:266–271.
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Affiliation(s)
- M. K. Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - M. C. Parry
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - L-R. Le Nail
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK; Centre Hospitalier Régional Universitaire (CHU) de Tours, Tours, France
| | - C. H. Wigley
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J. D. Stevenson
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - L. M. Jeys
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
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Thorkildsen J, Taksdal I, Bjerkehagen B, Haugland HK, Børge Johannesen T, Viset T, Norum OJ, Bruland Ø, Zaikova O. Chondrosarcoma in Norway 1990-2013; an epidemiological and prognostic observational study of a complete national cohort. Acta Oncol 2019; 58:273-282. [PMID: 30632866 DOI: 10.1080/0284186x.2018.1554260] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Knowledge of chondrosarcoma (CS) of bone to date is based on institutional reports and registry publications with limits in reporting, detail and quality of data. METHOD We have performed a retrospective search of CS of bone in the National Cancer Registry in Norway from 1990-2013, cross checked against local tumor databases with further quality control and supplementation of all data from clinical files. The time period is defined by the routine use of axial imaging in clinical practice. A total of 311 cases are included. We performed 108 pathological reviews and 223 radiological reviews. The manuscript was prepared according to the STROBE checklist for strengthening of observational studies. We performed uni-/multivariate cox analyses to define independent prognostic variables from the main cohort of central CS of bone. RESULTS The incidence of CS of bone in Norway is 2.85/million/yr. for both sexes overall, rising to 3.45/million/yr. in the last 5-year period. There is an increase in the most common central CS subtype, stronger for women than for men. Central CS had, in general 10-15% local recurrence rates, all evident by 5 years while metastasis rate increases with location and grade. Exceptions are extremity grade 1 CS which displayed no metastatic events and axial grade-3 disease with high rates (50%) of both local and metastatic relapse. Peripheral CS had limited metastatic potential (2%), but rates of local relapse (13%) continue to appear towards 10 years of follow up. Malignancy grade 3 independently predicts rate of metastasis and presence of soft tissue component predicts local recurrence, metastasis and survival. CONCLUSION Rates of local recurrence, metastasis and disease specific survival follow clear patterns depending on subtype, location and grade allowing better tailoring of follow-up regimes. Malignancy grade 3 and the presence of a soft tissue component independently predict behavior for central CS of bone.
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Affiliation(s)
- Joachim Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg Taksdal
- Department of Radiology, Oslo University Hospital-Radiumhospital, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital-Radiumhospital, Oslo, Norway
| | - Hans Kristian Haugland
- Cancer Registry of Norway, Oslo, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | | | - Trond Viset
- Department of Pathology, St Olav’s Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Ole-Jacob Norum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Øyvind Bruland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital-Radiumhospital, Oslo, Norway
| | - Olga Zaikova
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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hTERT promoter mutations in chondrosarcomas associate with progression and disease-related mortality. Mod Pathol 2018; 31:1834-1841. [PMID: 30065261 DOI: 10.1038/s41379-018-0098-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 01/22/2023]
Abstract
Chondrosarcomas are malignant skeletal tumors with chondroid differentiation. Prognosis is largely dependent on histological grading, which suffer from significant interobserver variability. Telomerase activity and abundant telomerase reverse transcriptase (hTERT) expression has previously been associated with chondrosarcoma grade and metastasis. We therefore analyzed the hTERT promoter in clinicopathologically well-characterized chondrosarcomas (grade 1-3) from 87 patients. Using Sanger sequencing we identified an activating -124 C > T mutation in 23 cases (26%). Promoter mutations were significantly associated with increased histological grade (8% of grade 1, 32% of grade 2 and 46% of grade 3, P = 0.002), suggesting a role in tumor progression. In four chondrosarcomas where the histopathological grade was heterogenous, the hTERT mutation was only identified in the higher-grade areas. Additionally, hTERT promoter mutations were significantly associated with worse metastasis-free survival (P = 0.018), chondrosarcoma-specific survival (P = 0.022) and older patient age (P = 0.003). These data suggest that hTERT promoter mutations are common in high grade conventional chondrosarcomas. Granted that additional studies can confirm these findings; hTERT promoter analysis could potentially serve as an adjuvant prognostic marker in routine chondrosarcoma grading. This study reinforces the rationale of telomerase targeted therapy in a subset of chondrosarcomas.
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Fei L, Ngoh C, Porter DE. Chondrosarcoma transformation in hereditary multiple exostoses: A systematic review and clinical and cost-effectiveness of a proposed screening model. J Bone Oncol 2018; 13:114-122. [PMID: 30591865 PMCID: PMC6303411 DOI: 10.1016/j.jbo.2018.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The most serious complication of hereditary multiple exostoses(HME) is chondrosarcoma transformation. Numerous authors have suggested that screening might allow early chondrosarcoma detection. However, literature-quoted incidences of malignant transformation are highly variable. METHODS A systematic review of malignant transformation by sex, exostosin-1 mutation(EXT1), age and site was conducted searching Medline, Embase and CINHAL. Three HME screening strategies were then developed and compared using cost per life-year gained and incremental cost-effectiveness ratio (ICER). RESULTS Systematic review: 18 papers with 852 chondrosarcomas were identified. The incidence of chondrosarcoma transformation averaged 4%, 75.2% occurring between ages 20-40 and 56.2% at the pelvis and proximal femur. Screening model: In the general HME population, plain radiographs provided cost per life-year gain of £19,013 compared to £53,392 in MRIs. ICER in MRIs compared to X-rays was £80,218. However, for every generation of HME patients screened over 20 years, X-ray radiation induced 0.65 cancers. Psychological effects of false-positives were marginal. Screening only higher-risk groups (males or EXT1) reduced cost but benefited fewer patients. CONCLUSIONS Our results suggest that annual MRI screening for all HME patients between age 20-40 may be of value. However, the extent of anatomical imaging is subject to debate; it is possible that focused imaging protocols which scan from cervical spine to proximal femur may improve cost-effectiveness.
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Affiliation(s)
- Li Fei
- Department of Orthopaedic Surgery, First affiliated Hospital of Tsinghua University, Beijing, 100016, China
| | - Clara Ngoh
- Department of Medicine, National University Health System, Singapore, 1E Kent Rigde Road, Level 10 NUHS Tower Block, 119228 Singapore
| | - Daniel E. Porter
- Department of Orthopaedic Surgery, First affiliated Hospital of Tsinghua University, Beijing, 100016, China
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Nazeri E, Gouran Savadkoohi M, Majidzadeh-A K, Esmaeili R. Chondrosarcoma: An overview of clinical behavior, molecular mechanisms mediated drug resistance and potential therapeutic targets. Crit Rev Oncol Hematol 2018; 131:102-109. [PMID: 30293700 DOI: 10.1016/j.critrevonc.2018.09.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/28/2018] [Accepted: 09/03/2018] [Indexed: 12/24/2022] Open
Abstract
Sarcomas are known as a heterogeneous class of cancers arisen in the connective tissues and demonstrated various histological subtypes including both soft tissue and bone origin. Chondrosarcoma is one of the main types of bone sarcoma that shows a considerable deficiency in response to chemotherapy and radiotherapy. While conventional treatment based on surgery, chemo-and radiotherapy are used in this tumor, high rate of death especially among children and adolescents are reported. Due to high resistance to current conventional therapies in chondrosarcoma, there is an urgent requirement to recognize factors causing resistance and discover new strategies for optimal treatment. In the past decade, dysregulation of genes associated with tumor development and therapy resistance has been studied to find potential therapeutic targets to overcome resistance. In this review, clinical aspects of chondrosarcoma are summarized. Moreover, it gives a summary of gene dysregulation, mutation, histone modifications and non-coding RNAs associated with tumor development and therapeutic response modulation. Finally, the probable role of tumor microenvironment in chondrosarcoma drug resistance and targeted therapies as a promising molecular therapeutic approach are summarized.
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Affiliation(s)
- Elahe Nazeri
- Genetics Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
| | | | - Keivan Majidzadeh-A
- Genetics Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
| | - Rezvan Esmaeili
- Genetics Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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van Praag (Veroniek) V, Rueten-Budde A, Ho V, Dijkstra P, Fiocco M, van de Sande M, van der Geest IC, Bramer JA, Schaap GR, Jutte PC, Schreuder HWB, Ploegmakers J. Incidence, outcomes and prognostic factors during 25 years of treatment of chondrosarcomas. Surg Oncol 2018; 27:402-408. [DOI: 10.1016/j.suronc.2018.05.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/26/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022]
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Fromm J, Klein A, Baur-Melnyk A, Knösel T, Lindner L, Birkenmaier C, Roeder F, Jansson V, Dürr HR. Survival and prognostic factors in conventional central chondrosarcoma. BMC Cancer 2018; 18:849. [PMID: 30143018 PMCID: PMC6109289 DOI: 10.1186/s12885-018-4741-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/10/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chondrosarcoma is the second most frequent primary malignant bone tumor. Treatment is mainly based on surgery. In general, wide resection is advocated at least in G2 and G3 tumors. But which margins should be achieved? Does localization as for example in the pelvis have a higher impact on survival than surgical margins themselves? METHODS From 1982 to 2014, 87 consecutive patients were treated by resection. The margin was defined as R0 (wide resection), R1 (marginal resection) or, R2 if the tumor was left intentionally. All patients were followed for evidence of local recurrence or distant metastasis. Overall and recurrence-free survival were calculated, significance analysis was performed. RESULTS In 54 (62%) cases a R0 resection, in 31 (36%) a R1 and in 2 (2%) patients a R2-resection was achieved. Histology proved to be G1 in 37 patients (43%), G2 in 41 (47%) and G3 in 9 cases (10%). 5-year local recurrence-free survival (LRFS) was 75%. Local recurrence-free survival showed a significant association with the margin status and the localization of the tumor with pelvic lesions doing worst. Metastatic disease was initially seen in 4 patients (4.6%), 19 others developed metastatic disease during follow-up. Overall survival of the entire group at 5 and 10 years were 79 and 75%, respectively. The quality of surgical margins and the presence of local recurrence did not influence overall survival in a multivariate analysis. Pelvic lesions had a worse prognosis as did higher grades of the tumor, metastatic disease and age. CONCLUSIONS The mainstay of therapy in Chondrosarcoma remains surgery. Risk factors as grading, metastatic disease, age and location significantly influence overall survival. Margin status (R0 vs. R1) did influence local recurrence-free survival but not overall survival. Chondrosarcomas of the pelvis have a higher risk of local recurrence and should be treated more aggressively.
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Affiliation(s)
- Julian Fromm
- Musculoskeletal Oncology, Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany
| | - Alexander Klein
- Musculoskeletal Oncology, Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Lars Lindner
- Department of Internal Medicine III (Oncology), University Hospital, LMU Munich, Munich, Germany
| | - Christof Birkenmaier
- Musculoskeletal Oncology, Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany
| | - Falk Roeder
- Department of Radiotherapy and Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volkmar Jansson
- Musculoskeletal Oncology, Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany
| | - Hans Roland Dürr
- Musculoskeletal Oncology, Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377, Munich, Germany.
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Waters DK, Elliott JA, O'Duffy F, O'Dwyer T. High-grade chondrosarcoma of the larynx: a case report and literature review. J Surg Case Rep 2018; 2018:rjy222. [PMID: 30151112 PMCID: PMC6101518 DOI: 10.1093/jscr/rjy222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/19/2018] [Accepted: 07/26/2018] [Indexed: 11/25/2022] Open
Abstract
A 64-year-old male presented with a 2-month history of sudden onset dysphonia. Endoscopic evaluation of the larynx revealed a complete right vocal cord palsy. Computed tomography of the neck revealed a mass medial to the right thyroid associated with the cricoid cartilage. Histologic examination confirmed high-grade chondrosarcoma. The patient underwent right-sided hemicricoidectomy with tracheal flap reconstruction, right thyroid lobectomy and partial oesophagectomy with primary anastomosis followed by adjuvant radiation therapy. He is currently being followed as an outpatient with no evidence of disease. High-grade chondrosarcoma of the larynx is an exceedingly rare tumour, associated with a poor prognosis. Current best evidence suggests primary surgical resection with negative margins. There is a lack of evidence to guide post-operative management of high-grade chondrosarcoma. They have a poor prognosis following surgical resection and a 10-year survival rate of 29%.
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Affiliation(s)
- Darragh K Waters
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland.,Department of Otorhinolarynogology, Mater Misercordiae University Hospital, Dublin, Ireland
| | - Jessie A Elliott
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland
| | - Tadgh O'Dwyer
- Department of Otorhinolarynogology, Mater Misercordiae University Hospital, Dublin, Ireland
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Intralesional vs. extralesional procedures for low-grade central chondrosarcoma: a systematic review of the literature. Arch Orthop Trauma Surg 2018; 138:929-937. [PMID: 29633075 DOI: 10.1007/s00402-018-2930-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Chondroid lesions are very common bone tumors. In most cases, they are benign enchondromas (EC) and, in a minor percentage, chondrosarcomas (CSs), the malignant counterpart. In the latter cases, surgery is the mainstay treatment, because they are chemo- and radio-resistant unless dedifferentiation occurs. If resection is recognized as the gold standard for intermediate-, high-grade tumors, and for low-grade chondrosarcoma (LG-CS) located in the spine and pelvis to reduce the risk of local recurrence, there is still no consensus in literature on the treatment of central low-grade chondrosarcoma (cLG-CS) located in the limbs. Our aim is to perform a review of literature on evidence supporting this approach or not. MATERIALS AND METHODS An electronic research of the medical archives was carried out in March 2017 seeking papers evaluating the results of curettage and resection in cLG-CS. RESULTS We selected 13 studies corresponding to our criteria. Unfortunately, they were descriptive, retrospective, non-randomized studies. We identified a population of 471 patients for a total of 473 low-grade chondrosarcomas. Two hundred and ninety-nine lesions were treated with curettage and 174 with wide surgery. The two groups were not homogeneous for diagnosis, size and staging, so no comparison between resection and curettage was possible. The global weighted average percentage of local recurrence was 6.7% (20 cases) and 10.9% (19 cases) after curettage and resection, respectively. No cases of metastasis were reported in the group treated with intralesional surgery, compared to five cases reported in the group treated with resection. Indications for surgery were given in most cases based on symptoms and imaging. CONCLUSIONS The absence of a preoperative histological diagnosis and the lack of a scientific method to conduct the studies do not sufficiently support curettage for low-grade chondrosarcomas. In the absence of this, resection must be considered a general rule for every malignancy. In our opinion, based on the low biological growth rate of low-grade chondrosarcoma, every chondromatous lesion can be followed-up. Biopsies must be performed based on clinical and radiological suspicions such as pain, scalloping or increase in size, rather than on performing a PET scan to evidence more informative high metabolic areas.
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Song K, Shi X, Wang H, Zou F, Lu F, Ma X, Xia X, Jiang J. Can a Nomogram Help to Predict the Overall and Cancer-specific Survival of Patients With Chondrosarcoma? Clin Orthop Relat Res 2018; 476:987-996. [PMID: 29470233 PMCID: PMC5916629 DOI: 10.1007/s11999.0000000000000152] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many factors have been reported to be associated with the prognosis of patients with chondrosarcoma, but clinicians have few tools to estimate precisely an individual patient's likelihood of surviving the illness. We therefore sought to develop effective nomograms to better estimate the survival of patients with chondrosarcoma. QUESTIONS/PURPOSES (1) Which clinicopathologic features are independent prognostic factors for patients with chondrosarcoma? (2) Can we develop a nomogram to predict 3- and 5-year overall and cancer-specific survival of individual patients with chondrosarcoma based on personalized information? METHODS We collected information on patients diagnosed with chondrosarcoma between 1988 and 2011 from the Surveillance, Epidemiology, and End Results (SEER) database. The SEER database consists of 18 cancer registries and covers approximately 30% of the total United States population. One thousand thirty-four adult patients with grade II or III chondrosarcoma were included in the cohort (patients with grade I chondrosarcoma were not evaluated in this study), while 327 patients were excluded from the study owing to missing data regarding tumor size or metastasis. Nine hundred nineteen patients (89%) in the cohort had complete followup for at least 1 year. The X-tile program was used to determine optimal cutoff points. Univariate and multivariate analyses were applied to identify independent factors that were further included in the nomograms predicting 3- and 5-year overall survival and cancer-specific survival. Records of 1034 patients were collected and randomly divided into training (n = 517) and validation (n = 517) cohorts. The nomograms were developed based on training cohort. Data for the training cohort were obtained for internal validation of the nomograms, whereas data for the validation cohort were obtained for external validation of the nomograms. Bootstrapped validation, which used a resample with 500 iterations, was applied to validate the nomograms internally and externally. RESULTS Six independent prognostic factors for overall survival and six for cancer-specific survival were identified and incorporated to construct nomograms for 3- and 5-year overall and cancer-specific survival. These nomograms can easily be used by providers in the office to estimate a patient's prognosis; the only clinical details a provider needs to use these nomograms effectively are age, histologic subtype, tumor grade, whether surgery was performed, tumor size, and the presence or absence of metastases. Internal and external calibration plots for the probability of 3- and 5-year overall survival and cancer-specific survival showed good agreement between nomogram prediction and observed outcomes. The concordance indices (C-indices) for internal validation of overall survival and cancer-specific survival prediction were 0.803 and 0.829, respectively, whereas the C-indices for external validation were 0.753 and 0.759, respectively. CONCLUSIONS We were able to develop effective nomograms to predict overall survival and cancer-specific survival for patients with chondrosarcoma; these nomograms require only basic information, which should be available to all providers in the office setting. If these observations can be validated in different registries or databases, the nomograms can assist clinicians in counseling patients regarding therapeutic choices. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Kehan Song
- K. Song, H. Wang, F. Zou, F. Lu, X. Ma, X. Xia, J. Jiang, Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China X. Shi, Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
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Song K, Shi X, Liang X, Wang H, Zou F, Lu F, Ma X, Jiang J. Risk factors for metastasis at presentation with conventional chondrosarcoma: a population-based study. INTERNATIONAL ORTHOPAEDICS 2018; 42:2941-2948. [PMID: 29681020 DOI: 10.1007/s00264-018-3942-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of the study was to investigate risk factors for metastasis at diagnosis. METHODS We collected patients diagnosed with conventional chondrosarcoma between 1983 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Each patient was classified as having metastatic or localized disease. Univariate and multivariate logistic regression analyses were applied to determine which characteristics were risk factors for metastasis at diagnosis. RESULTS Two thousand three hundred forty-nine patients were collected and 180 patients had metastasis at presentation. Data on age, gender, primary site, grade, and tumour size were enrolled into the multivariate logistic analysis. Greater age (60 years or older: OR = 1.872, 95% CI, 1.206 to 2.904), axial or craniofacial location (spine: OR = 1.775, 95% CI, 1.188 to 2.651; thoracic cage: OR = 2.034, 95% CI, 1.321 to 3.134; craniofacial bones: OR = 5.507, 95% CI, 3.001 to 10.107), higher grade (grade II: OR = 1.849, 95%CI, 1.181 to 2.895; grade III: OR = 4.016, 95%CI, 2.513 to 6.418), and larger tumour size (size over 10 cm: OR = 7.135, 95%CI, 2.130 to 23.893) were associated with an increased risk of metastasis at presentation. CONCLUSIONS Conventional chondrosarcoma patients with greater age, axial or craniofacial tumour location, higher grade, and larger tumor size were more likely to have metastasis at diagnosis.
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Affiliation(s)
- Kehan Song
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Xiao Shi
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Liang
- Department of Ophthalmology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongli Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Fei Zou
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Feizhou Lu
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Xiaosheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China.
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Stevens JW, Meyerholz DK, Neighbors JD, Morcuende JA. 5'-methylschweinfurthin G reduces chondrosarcoma tumor growth . J Orthop Res 2018; 36:1283-1293. [PMID: 28960476 DOI: 10.1002/jor.23753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/20/2017] [Indexed: 02/04/2023]
Abstract
New treatment options are urgently required in the field of chondrosarcoma, particularly of chondrosarcomas with a well-differentiated hyaline cartilage-like extracellular matrix (e.g., collagen II and proteoglycan-rich) phenotype, notoriously resistant to drug penetration, and having potential of progression towards higher grade. We investigated the feasibility of using 5'-methylschweinfurthin G (MeSG) as a tumor suppressor agent in the Swarm rat chondrosarcoma, an intermediate- to high-grade chondrosarcoma model, having a hyaline cartilage-like phenotype. Tumor cell culture studies were performed to identify their proliferative and cytotoxicity sensitivity to MeSG. Tumor burden mice were treated with MeSG and analyzed for tumor growth, morphology and regression. The chondrosarcoma tumor cells had a half maximum cytotoxicity concentration (IC50 ) of 35 nM MeSG; approximately 300-fold less than freshly isolated rat chondrocytes (IC50 of 11 µM). Multiple injections of MeSG (20 mg/kg, body weight) resulted in reduced/eliminated tumor growth over a 17-day period in mice, and an 83% reduction (p = 0.023) in tumor mass. Three out of ten MeSG treated mice had complete elimination of tumor. Tumors of treated mice had a decrease in chondrosarcoma cell proliferation (p = 0.012) and an increase in cell death (p = 0.030) compared with tumors of control mice. These findings in an animal model demonstrate the effectiveness of MeSG for treatment of rat chondrosarcomas, and may have the potential use as a therapeutic option for the difficult-to-treat intermediate-to high-grade hyaline cartilage-like chondrosarcoma. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1283-1293, 2018.
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Affiliation(s)
- Jeff W Stevens
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, 500 Newton Road, 3160 ML, Iowa City, 52242, Iowa
| | - David K Meyerholz
- Department of Pathology, Carver College of Medicine, The University of Iowa, 500 Newton Road, 1165 ML, Iowa City, 52242, Iowa
| | - Jeffery D Neighbors
- Departments of Pharmacology and Medicine, Pennsylvania State College of Medicine, Pennsylvania State Cancer Institute, 500 University Drive, CH72, Hershey, 17033, Pennsylvania
| | - José A Morcuende
- Department of Orthopaedic Surgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 01023 JPP, Iowa City, 52242, Iowa
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Farfalli GL, Albergo JI, Piuzzi NS, Ayerza MA, Muscolo DL, Ritacco LE, Aponte-Tinao LA. Is Navigation-guided En Bloc Resection Advantageous Compared With Intralesional Curettage for Locally Aggressive Bone Tumors? Clin Orthop Relat Res 2018. [PMID: 29529633 PMCID: PMC6260034 DOI: 10.1007/s11999.0000000000000054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of locally aggressive bone tumors is a balance between achieving local tumor control and surgical morbidity. Wide resection decreases the likelihood of local recurrence, although wide resection may result in more complications than would happen after curettage. Navigation-assisted surgery may allow more precise resection, perhaps making it possible to expand the procedure's indications and decrease the likelihood of recurrence; however, to our knowledge, comparative studies have not been performed. QUESTIONS/PURPOSES The purpose of this study was to compare curettage plus phenol as a local adjuvant with navigation-guided en bloc resection in terms of (1) local recurrence; (2) nononcologic complications; and (3) function as measured by revised Musculoskeletal Tumor Society (MSTS) scores. METHODS Patients with a metaphyseal and/or epiphyseal locally aggressive primary bone tumor treated by curettage and adjuvant therapy or en bloc resection assisted by navigation between 2010 and 2014 were considered for this retrospective study. Patients with a histologic diagnosis of a primary aggressive benign bone tumor or low-grade chondrosarcoma were included. During this time period, we treated 45 patients with curettage of whom 43 (95%) were available for followup at a minimum of 24 months (mean, 37 months; range, 24-61 months), and we treated 26 patients with navigation-guided en bloc resection, of whom all (100%) were available for study. During this period, we generally performed curettage with phenol when the lesion was in contact with subchondral bone. We treated tumors that were at least 5 mm from the subchondral bone, such that en bloc resection was considered possible with computer-assisted block resection. There were no differences in terms of age, gender, tumor type, or tumor location between the groups. Outcomes, including allograft healing, nonunion, tumor recurrence, fracture, hardware failure, infection, and revised MSTS score, were recorded. Bone consolidation was defined as complete periosteal and endosteal bridging visible between the allograft-host junctions in at least two different radiographic views and the absence of pain and instability in the union site. All study data were obtained from our longitudinally maintained oncology database. RESULTS In the curettage group, two patients developed a local recurrence, and no local recurrences were recorded in patients treated with en bloc resection. All patients who underwent navigation-guided resection achieved tumor-free margins. Intraoperative navigation was performed successfully in all patients and there were no failures in registration. Postoperative complications did not differ between the groups: in patients undergoing curettage, 7% (three of 43) and in patients undergoing navigation, 4% (one of 26) had a complication. There was no difference in functional scores: mean MSTS score for patients undergoing curettage was 28 points (range, 27-30 points) and for patients undergoing navigation, 29 (range, 27-30 points; p = 0.10). CONCLUSIONS In this small comparative series, navigation-assisted resection techniques allowed conservative en bloc resection of locally aggressive primary bone tumors with no local recurrence. Nevertheless, with the numbers available, we saw no difference between the groups in terms of local recurrence risk, complications, or function. Until or unless studies demonstrate an advantage to navigation-guided en bloc resection, we cannot recommend wide use of this novel technique because it adds surgical time and expense. LEVEL OF EVIDENCE Level III, therapeutic study.
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Bus MPA, Campanacci DA, Albergo JI, Leithner A, van de Sande MAJ, Gaston CL, Caff G, Mettelsiefen J, Capanna R, Tunn PU, Jeys LM, Dijkstra PDS. Conventional Primary Central Chondrosarcoma of the Pelvis: Prognostic Factors and Outcome of Surgical Treatment in 162 Patients. J Bone Joint Surg Am 2018; 100:316-325. [PMID: 29462035 DOI: 10.2106/jbjs.17.00105] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies focusing on the oncological outcome after treatment of conventional primary central chondrosarcoma of pelvic bone are lacking. We conducted this retrospective study at 5 referral centers to gain insight in the outcome of treatment for this tumor type and to identify risk factors for impaired oncological outcome. METHODS One hundred and sixty-two consecutive patients (118 male patients [73%]) who underwent resection of a conventional primary central chondrosarcoma of pelvic bone from 1985 to 2013 were evaluated. The median age was 51 years (range, 15 to 78 years). The median follow-up was 12.6 years (95% confidence interval [CI], 8.4 to 16.9 years). There were 30 grade-I lesions (19%), 93 grade-II lesions (57%), and 39 grade-III lesions (24%). RESULTS Sixty-two patients (38%) experienced local recurrence: 9 grade-I lesions (30%), 31 grade-II lesions (33%), and 22 grade-III lesions (56%). Forty-eight patients (30%) developed metastases. The risk of disease-related death was 3% for grade-I tumors (1 of 30; this patient had a grade-II recurrence and died of metastases), 33% (31 of 93) for grade-II tumors, and 54% (21 of 39) for grade-III tumors. Identified risk factors for impaired disease-specific survival were tumor grade (grade II: hazard ratio [HR], 20.18; p = 0.003; and grade III: HR, 58.94; p < 0.001), resection margins (marginal: HR, 3.21; p = 0.001; and intralesional: HR, 3.56; p < 0.001), and maximal tumor size (HR, 1.08 per cm; p = 0.026). Deep infection (19% [n = 31]) was the predominant complication. CONCLUSIONS This study offers a standard for survival rates for conventional primary central chondrosarcoma of the pelvis. The survival for grade-I tumors was excellent. Wide resection margins were associated with a significant survival advantage for higher-grade tumors. Because of the inability to reliably distinguish low-grade and high-grade tumors preoperatively, we conclude that any central pelvic chondrosarcoma should be treated with aggressive primary resection with the aim of obtaining wide resection margins. There may be aggressive biologic features in some tumors for which a surgical procedure alone may not be adequate to improve outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michaël P A Bus
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Domenico A Campanacci
- Center for Traumatology and Orthopaedics, Careggi University Hospital, Florence, Italy
| | - Jose I Albergo
- Royal Orthopaedic Hospital Oncology Service, Birmingham, United Kingdom
| | - Andreas Leithner
- Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | | | - Czar Louie Gaston
- Royal Orthopaedic Hospital Oncology Service, Birmingham, United Kingdom
| | - Giuseppe Caff
- Center for Traumatology and Orthopaedics, Careggi University Hospital, Florence, Italy
| | - Jan Mettelsiefen
- Helios Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | - Rodolfo Capanna
- Center for Traumatology and Orthopaedics, Careggi University Hospital, Florence, Italy
| | - Per-Ulf Tunn
- Helios Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | - Lee M Jeys
- Royal Orthopaedic Hospital Oncology Service, Birmingham, United Kingdom
| | - P D Sander Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Treatment strategies for central low-grade chondrosarcoma of long bones: a systematic review of the literature and meta-analysis. Musculoskelet Surg 2017; 102:95-109. [PMID: 28986742 DOI: 10.1007/s12306-017-0507-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/25/2017] [Indexed: 02/06/2023]
Abstract
The need for wide local excision (WLE) versus intralesional (IL) treatment of low-grade chondrosarcomas (CS) of the appendicular skeleton remains controversial. We sought to perform a systematic review and meta-analysis to compare different conventional types of surgical treatments for grade I CS in terms of: (1) rate of local recurrence (LR) and metastases, (2) functional outcome as measured by the Musculoskeletal Tumor Society (MSTS) score, (3) complication rate. Eighteen studies enrolling 695 patients met our criteria. Studies reported on WLE versus IL treatment (n = 7), and IL treatment with or without different adjuvants (N = 11). The LR rate was not significantly different between WLE and IL treatment (OR 2.31; 95% CI, 0.85-6.2; P = 0.1). On the contrary, complication rates were significantly lower in favor of IL treatment (OR 2.27; 95% CI, 0.07-0.72; P = 0.012). The mean reported MSTS score ranged from 21.8 to 28.2 for WLE and from 26.5 to 29.7 for IL treatment, with a significant difference in favor of IL treatment. IL treatment as an alternative to WLE does not greatly increase the risk of LR or metastasis and has lower complication rates with better functional scores. In light of the retrospective nature of the studies available, our findings should be interpreted with caution.
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Peterse EFP, van den Akker BEWM, Niessen B, Oosting J, Suijker J, de Jong Y, Danen EHJ, Cleton-Jansen AM, Bovée JVMG. NAD Synthesis Pathway Interference Is a Viable Therapeutic Strategy for Chondrosarcoma. Mol Cancer Res 2017; 15:1714-1721. [PMID: 28860121 DOI: 10.1158/1541-7786.mcr-17-0293] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/18/2017] [Accepted: 08/28/2017] [Indexed: 11/16/2022]
Abstract
Nicotinamide phosphoribosyltransferase (NAMPT) and nicotinic acid phosphoribosyltransferase (NAPRT) are rate-limiting enzymes in the NAD+ synthesis pathway. Chondrosarcoma is a malignant cartilage forming bone tumor, in which mutations altering isocitrate dehydrogenase-1 and -2 (IDH1 and IDH2) activity have been identified as potential driver mutations. Vulnerability for NAD+ depletion has been reported for IDH1/2-mutant cells. Here, the potency of NAMPT inhibitors as a treatment of chondrosarcoma was explored. Eleven chondrosarcoma cell lines were treated with NAMPT inhibitors, in which the effect on cell viability, colony formation, and 3D collagen invasion was assessed. The expression level of NAMPT and NAPRT transcripts in chondrosarcoma cells was determined by qRT-PCR. Methylation of the NAPRT promoter was evaluated using a previously published dataset of genome-wide methylation. In addition, a methylation dataset was used to determine methylation of the NAPRT promoter in 20 IDH1/2-mutated cartilage tumors. Chondrosarcoma cells showed a dose-dependent decrease in cell viability, 3D collagen invasion, and colony formation upon treatment with NAMPT inhibitors, in which nearly half of the cell lines demonstrated absolute IC50s in the low nanomolar range. Increasing IC50s correlated to increasing NAPRT expression levels and decreasing NAPRT promoter methylation. No correlation between IDH1/2 mutation status and sensitivity for NAMPT inhibitors was observed. Strikingly, higher methylation of the NAPRT promoter was observed in high-grade versus low-grade chondrosarcomas. In conclusion, this study identified NAMPT as a potential target for treatment of chondrosarcoma.Implications: Chondrosarcoma patients, especially those of high histologic grade with lower expression and hypermethylation of NAPRT, may benefit from inhibition of the NAD synthesis pathway. Mol Cancer Res; 15(12); 1714-21. ©2017 AACR.
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Affiliation(s)
| | | | - Bertine Niessen
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johnny Suijker
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne de Jong
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik H J Danen
- Division of Toxicology, Leiden Academic Center for Drug Research, Leiden University, Leiden, the Netherlands
| | | | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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Stihsen C, Panotopoulos J, Puchner SE, Sevelda F, Kaider A, Windhager R, Funovics PT. The outcome of the surgical treatment of pelvic chondrosarcomas: a competing risk analysis of 58 tumours from a single centre. Bone Joint J 2017; 99-B:686-696. [PMID: 28455480 DOI: 10.1302/0301-620x.99b5.bjj-2016-0761.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/09/2016] [Indexed: 11/05/2022]
Abstract
AIMS Few studies dealing with chondrosarcoma of the pelvis are currently available. Different data about the overall survival and prognostic factors have been published but without a detailed analysis of surgery-related complications. We aimed to analyse the outcome of a series of pelvic chondrosarcomas treated at a single institution, with particular attention to the prognostic factors. Based on a competing risk model, our objective was to identify risk factors for the development of complications. PATIENTS AND METHODS In a retrospective single-centre study, 58 chondrosarcomas (26 patients alive, 32 patients dead) of the pelvis were reviewed. The mean follow-up was 13 years (one week to 23.1 years). RESULTS A total of 26 patients (45%) were alive and 32 patients (55%) had died. Overall survival was 76%, 55% and 45% at one, five and ten years post-operatively, respectively. In a competing risk model the cumulative risk of the development of a surgery-related complication was 64% at six months and 69% at one year, post-operatively, respectively. Endoprosthetic reconstruction was a significant risk factor for the development of complications (p = 0.006). Complications were not significantly related to age or the location or grade of the tumour (p = 0.823, p = 0.976, p = 0.858). The development of complications did not have a negative effect on survival (p = 0.147). CONCLUSION This is the first study with competing risk analysis of surgery-related complications in patients with a pelvic chondrosarcoma. The surgery in these patients remains prone to complications. Endoprosthetic reconstruction significantly increases the risk of the development of complications (p = 0.006). A competing risk model showed that the development of complications does not have a negative influence on overall survival (p = 0.147). An aggressive, surgical resection with the goal of achieving wide margins whenever possible remains the mainstay of treatment. Cite this article: Bone Joint J 2017;99-B:686-96.
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Affiliation(s)
- C Stihsen
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - J Panotopoulos
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - S E Puchner
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - F Sevelda
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - A Kaider
- Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - R Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - P T Funovics
- Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Abstract
PURPOSE OF REVIEW The prognosis of patients with unresectable or metastatic chondrosarcoma of the bone is poor. Chondrosarcomas are in general resistant to chemotherapy and radiotherapy. This review discusses recent developments in the characterization of molecular pathways involved in the oncogenesis of chondrosarcoma that should be explored to improve prognosis of patients with advanced chondrosarcoma. RECENT FINDINGS The different oncogenic pathways for chondrosarcoma have become better defined. These include alterations in pathways such as isocitrate dehydrogenase mutation, hedgehog signalling, the retinoblastoma protein and p53 pathways, apoptosis and survival mechanisms, and several tyrosine kinases. These specific alterations can be employed for use in clinical interventions in advanced chondrosarcoma. SUMMARY As many different genetic alterations in chondrosarcoma have been identified, it is of the utmost importance to classify druggable targets that may improve the prognosis of chondrosarcoma patients. In recent years an increased number of trials evaluating targeted therapies are being conducted. As chondrosarcoma is an orphan disease consequently all studies are performed with small numbers of patients. The results of clinical studies so far have been largely disappointing. Therapeutic intervention studies of these new targets emerging from preclinical studies are of highest importance to improve prognosis of chondrosarcoma patients with advanced disease.
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Chen X, Yu LJ, Peng HM, Jiang C, Ye CH, Zhu SB, Qian WW. Is intralesional resection suitable for central grade 1 chondrosarcoma: A systematic review and updated meta-analysis. Eur J Surg Oncol 2017; 43:1718-1726. [PMID: 28666625 DOI: 10.1016/j.ejso.2017.05.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/01/2017] [Accepted: 05/18/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The surgical choice for grade 1 chondrosarcoma has been debated for decades. Intralesional resection can minimize the damage caused by surgery and offer better functional outcome. However, controversy remains about whether it will result in higher rates of local recurrence and metastasis, fewer complications, and better functional outcome compared with resection with wide margin. This systematic review and updated meta-analysis therefore compared intralesional resection and resection with wide margin in terms of local recurrence, metastasis, complications, and functional outcome. METHODS Medline, Embase, and the Cochrane Library were comprehensively searched in December 2016 to identify studies comparing intralesional resection and resection with wide margin for central grade 1 chondrosarcoma. Data of interest were extracted and analyzed using Review Manager 5.3. RESULTS Ten studies involving 394 patients were included, with 214 patients who had intralesional resection and 180 patients who had resection with wide margin for grade 1 chondrosarcoma. Intralesional resection was associated with lower complication rates (P < 0.0001) and better Musculoskeletal Tumor Society score (MSTS). There were no significant differences in terms of overall local recurrence (P = 0.27), local recurrence based on adjuvant therapies (P = 0.22), local recurrence in studies that included lesions of the hand, foot, pelvis, and axial skeleton (P = 0.55), and metastasis (P = 0.74) between groups. CONCLUSION Intralesional resection provides lower complications and better functional outcome with no significant increase in the risk of recurrence and metastasis. We think it is a suitable treatment for central grade 1 chondrosarcoma.
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Affiliation(s)
- X Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science China, 100730, Beijing, China.
| | - L J Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science China, 100730, Beijing, China
| | - H M Peng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science China, 100730, Beijing, China
| | - C Jiang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science China, 100730, Beijing, China
| | - C H Ye
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science China, 100730, Beijing, China
| | - S B Zhu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science China, 100730, Beijing, China
| | - W W Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science China, 100730, Beijing, China.
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Genetic aberrations and molecular biology of skull base chordoma and chondrosarcoma. Brain Tumor Pathol 2017; 34:78-90. [PMID: 28432450 DOI: 10.1007/s10014-017-0283-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/27/2017] [Indexed: 12/20/2022]
Abstract
Chordomas and chondrosarcomas are two major malignant bone neoplasms located at the skull base. These tumors are rarely metastatic, but can be locally invasive and resistant to conventional chemotherapies and radiotherapies. Accordingly, therapeutic approaches for the treatment of these tumors can be difficult. Additionally, their location at the skull base makes them problematic. Although accurate diagnosis of these tumors is important because of their distinct prognoses, distinguishing between these tumor types is difficult due to overlapping radiological and histopathological findings. However, recent accumulation of molecular and genetic studies, including extracranial location analysis, has provided us clues for accurate diagnosis. In this report, we review the genetic aberrations and molecular biology of these two tumor types. Among the abundant genetic features of these tumors, brachyury immunohistochemistry and direct sequencing of IDH1/2 are simple and useful techniques that can be used to distinguish between these tumors. Although it is still unclear why these tumors, which have such distinct genetic backgrounds, show similar histopathological findings, comparison of their genetic backgrounds could provide essential information.
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71
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Nota SPFT, Russchen MJAM, Raskin KA, Mankin HJ, Hornicek FJ, Schwab JH. Functional and oncological outcome after surgical resection of the scapula and clavicle for primary chondrosarcoma. Musculoskelet Surg 2017; 101:67-73. [PMID: 27900545 DOI: 10.1007/s12306-016-0437-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/06/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The scapula is a relatively common site for chondrosarcoma to develop in contrary to the clavicle, which is rarely affected by these tumors. The aim of this study is to determine the functional and oncological outcome for patients treated operatively for scapular or clavicular chondrosarcoma. METHODS In this single-center retrospective study, we included a sample of 20 patients that received the diagnosis of a primary chondrosarcoma of the scapula or clavicle. Of the surviving patients, the functional function was assessed using the DASH and the PROMIS Physical Function-Upper Extremity. Patients were longitudinally tracked for their oncological outcome. RESULTS All patients were followed for at least 2 years or until death. The mean age of the cohort was 47 years. Eighteen patients suffered from a chondrosarcoma of the scapula, and in 2 patients, the tumor was located in the clavicle. Metastasis, local recurrence and a higher tumor grade were all associated with a decreased overall survival. For the patients with a chondrosarcoma of the scapula, the average DASH score was 16 ± 16 and the mean PROMIS Physical Function-Upper Extremity score was 48 ± 10. Patients with both an intact rotator cuff and glenoid had a better physical function. CONCLUSIONS Upper extremity function after (partial) scapulectomy varied depending on whether the glenoid was spared and whether a functioning shoulder abductor remained. When the resection spared these structures, then excellent functional outcomes were reported. Oncologic outcomes depended upon the grade of the tumor and whether local recurrence and metastases occurred.
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Affiliation(s)
- S P F T Nota
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA.
| | - M J A M Russchen
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - K A Raskin
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - H J Mankin
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - F J Hornicek
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
| | - J H Schwab
- Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey Center, Suite 3B, 55 Fruit Street, Boston, MA, 02114, USA
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Bhatt AD, Jacobson A, Lee RY, Giraud C, Schwab JH, Hornicek FJ, Nielsen P, Choy E, Harmon D, DeLaney TF, Chen YLE. High-Dose Proton Beam-Based Radiation Therapy in the Management of Extracranial Chondrosarcomas. Int J Part Ther 2017; 3:373-381. [PMID: 31772986 PMCID: PMC6871608 DOI: 10.14338/ijpt-16-00018.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/07/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Radiation therapy (RT) improves local tumor control in axial chondrosarcomas (CS). It is, however, often difficult to safely deliver the high doses (range, 70.2-77.4 Gy) required for achieving a high likelihood of local control, especially in the spine, using photons. This, however, can be achieved with proton beam therapy (PBT) due to its unique physical characteristics. The main goal of our study is to evaluate the outcomes of CS patients treated with passive scattered PBT. MATERIALS AND METHODS Forty-four patients (N = 44) were identified who received PBT as part of their treatment from 1990 to 2012. A retrospective review of their medical and RT treatment records was conducted. Multivariate analyses were performed to identify patient- and tumor-related factors predicting for improved local control and overall survival. RESULTS Median age was 45.5 years and 55% were female. Median tumor size was 13 cm. Most common anatomical location was the spine (80%). Median follow-up was 29.1 months. Median external beam RT dose was 70.2 Gy relative biological effectiveness (RBE) at 1.8 Gy (RBE) per fraction typically administered using a combination of photon RT + PBT (77%) or PBT alone (23%). Local control was 76% and 57%, and overall survival was 90% and 68% at 2 and 5 years, respectively. Toxicity was acceptable, with the most frequent being wound complications (16%). On multivariate analyses, grade III tumors were significantly associated with decreased local control (P = 0.019), while female sex (P = 0.037) and grade III tumors (P = 0.005) were associated with a poorer overall survival. CONCLUSIONS High-dose proton-based RT in combination with surgery resulted in local tumor control in most of these high-risk CS patients. Female sex was predictive for decreased survival, while higher tumor grade (grade III) was predictive of decreased local control and survival. Proton beam therapy is an attractive treatment modality for these challenging tumors.
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Affiliation(s)
- Aashish D. Bhatt
- The Massachusetts General Hospital Francis H. Burr Proton Therapy Center, Boston, MA, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Alex Jacobson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Y. Lee
- Department of Radiation Oncology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Christine Giraud
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph H. Schwab
- Orthopedic Oncology, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Francis J. Hornicek
- Orthopedic Oncology, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Edwin Choy
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - David Harmon
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas F. DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Yen-Lin E. Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
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Zhang L, Yang M, Mayer T, Johnstone B, Les C, Frisch N, Parsons T, Mi QS, Gibson G. Use of MicroRNA biomarkers to distinguish enchondroma from low-grade chondrosarcoma. Connect Tissue Res 2017; 58:155-161. [PMID: 27267924 DOI: 10.1080/03008207.2016.1197212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Establishing a definitive diagnosis between benign enchondroma versus low-grade chondrosarcoma presents a potential challenge to both clinicians and pathologists. microRNAs (small non-coding RNAs) have proven to be effective biomarkers for the identification of tumors and tumor progression. We present analysis, both array and quantitative PCR, that shows consistently and substantially increased expression of two microRNAs, miRs-181a and -138, in low-grade chondrosarcomas compared with enchondromas. The data suggest these microRNAs would provide an analytical distinction between the chondrosarcoma and benign neoplasms that can be performed in formalin-fixed paraffin-embedded specimens. Together with recent publications, these data indicate that miRs-181a and -138 also play a role in tumor development and homeostasis and may provide new targets for the development of much needed therapeutic intervention.
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Affiliation(s)
- Liang Zhang
- a Bone and Joint Center , Henry Ford Hospital , Detroit , MI , USA
| | - Maozhou Yang
- a Bone and Joint Center , Henry Ford Hospital , Detroit , MI , USA
| | - Theodore Mayer
- b Department of Pathology , Henry Ford Hospital , Detroit , MI , USA
| | - Brian Johnstone
- c Department of Orthopaedics and Rehabilitation , Oregon Health and Science University , Portland , OR , USA
| | - Clifford Les
- a Bone and Joint Center , Henry Ford Hospital , Detroit , MI , USA
| | - Nicholas Frisch
- d Department of Orthopaedic Surgery , Henry Ford Hospital , Detroit , MI , USA
| | - Theodore Parsons
- d Department of Orthopaedic Surgery , Henry Ford Hospital , Detroit , MI , USA
| | - Qing-Sheng Mi
- e Department of Dermatology , Henry Ford Hospital , Detroit , MI , USA
| | - Gary Gibson
- a Bone and Joint Center , Henry Ford Hospital , Detroit , MI , USA
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[Protocol for the study of bone tumours and standardization of pathology reports]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2016; 50:34-44. [PMID: 29179963 DOI: 10.1016/j.patol.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 01/21/2023]
Abstract
Primary bone neoplasms represent a rare and heterogeneous group of mesenchymal tumours. The prevalence of benign and malignant tumours varies; the latter (sarcomas) account for less than 0.2% of all malignant tumours. Primary bone neoplasms are usually diagnosed and classified according to the criteria established and published by the World Health Organization (WHO 2013). These criteria are a result of advances in molecular pathology, which complements the histopathological diagnosis. Bone tumours should be diagnosed and treated in referral centers by a multidisciplinary team including pathologists, radiologists, orthopedic surgeons and oncologists. We analyzed different national and international protocols in order to provide a guide of recommendations for the improvement of pathological evaluation and management of bone tumours. We include specific recommendations for the pre-analytical, analytical, and post-analytical phases, as well as protocols for gross and microscopic pathology.
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75
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Peterse EFP, Cleven AHG, De Jong Y, Briaire-de Bruijn I, Fletcher JA, Danen EHJ, Cleton-Jansen AM, Bovée JVMG. No preclinical rationale for IGF1R directed therapy in chondrosarcoma of bone. BMC Cancer 2016; 16:475. [PMID: 27418340 PMCID: PMC4946092 DOI: 10.1186/s12885-016-2522-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/05/2016] [Indexed: 12/23/2022] Open
Abstract
Background Chondrosarcoma is a malignant cartilage forming bone tumour for which no effective systemic treatment is available. Previous studies illustrate the need for a better understanding of the role of the IGF pathway in chondrosarcoma to determine if it can be a target for therapy, which was therefore explored in this study. Methods Expression of mediators of IGF1R signalling and phosphorylation status of IRS1 was determined in chondrosarcoma cell lines by qRT-PCR and western blot. The effect of activation and inhibition of IGF1R signalling on downstream targets was assessed by western blot. Ten chondrosarcoma cell lines were treated with OSI-906 (IGF1R and IR dual inhibitor) after which cell proliferation and migration were determined by a viability assay and the xCELLigence system, respectively. In addition, four chondrosarcoma cell lines were treated with a combination of doxorubicin and OSI-906. By immunohistochemistry, IGF1R expression levels were determined in tissue microarrays of 187 cartilage tumours and ten paraffin embedded cell lines. Results Mediators of IGF1R signalling are heterogeneously expressed and phosphorylated IRS1 was detected in 67 % of the tested chondrosarcoma cell lines, suggesting that IGF1R signalling is active in a subset of chondrosarcoma cell lines. In the cell lines with phosphorylated IRS1, inhibition of IGF1R signalling decreased phosphorylated Akt levels and increased IGF1R expression, but it did not influence MAPK or S6 activity. In line with these findings, treatment with IGF1R/IR inhibitors did not impact proliferation or migration in any of the chondrosarcoma cell lines, even upon stimulation with IGF1. Although synergistic effects of IGF1R/IR inhibition with doxorubicin are described for other cancers, our results demonstrate that this was not the case for chondrosarcoma. In addition, we found minimal IGF1R expression in primary tumours in contrast to the high expression detected in chondrosarcoma cell lines, even if both were derived from the same tumour, suggesting that in vitro culturing upregulates IGF1R expression. Conclusions The results from this study indicate that the IGF pathway is not essential for chondrosarcoma growth, migration or chemoresistance. Furthermore, IGF1R is only minimally expressed in chondrosarcoma primary tumours. Therefore, the IGF pathway is not expected to be an effective therapeutic target for chondrosarcoma of bone. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2522-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Arjen H G Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne De Jong
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jonathan A Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Erik H J Danen
- Division of Toxicology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | | | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
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Ellis MA, Gerry DR, Byrd JK. Head and neck chondrosarcomas: Analysis of the Surveillance, Epidemiology, and End Results database. Head Neck 2016; 38:1359-66. [PMID: 27042949 DOI: 10.1002/hed.24434] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/09/2015] [Accepted: 01/31/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chondrosarcoma is a rare tumor of the head and neck. Because of the limited clinical data, no studies have conducted a thorough comparison between head and neck chondrosarcomas and those arising at other body sites. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, we compared 682 patients with chondrosarcomas of the head and neck with 4757 patients with non-head and neck chondrosarcomas, evaluating disease-specific survival (DSS) and overall survival (OS) based on tumor location, histology, grade, stage, and treatment. RESULTS Head and neck chondrosarcomas displayed a lower grade (p < .001) and stage (p < .0001) compared with other chondrosarcomas. Overall, chondrosarcomas of the head and neck had significantly higher DSS and OS than non-head and neck chondrosarcomas (p < .001). CONCLUSION Chondrosarcomas of the head and neck display a lower grade and stage compared with other chondrosarcomas. DSS and OS were significantly greater for chondrosarcomas of the head and neck. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1359-1366, 2016.
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Affiliation(s)
- Mark A Ellis
- Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia at Georgia Regents University, Augusta, Georgia
| | - Daniel R Gerry
- Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia at Georgia Regents University, Augusta, Georgia
| | - J Kenneth Byrd
- Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia at Georgia Regents University, Augusta, Georgia
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González Del Pino J, Lozano Calderón SA, Chebib I, Jupiter JB. Intralesional Versus Wide Resection of Low-Grade Chondrosarcomas of the Hand. J Hand Surg Am 2016; 41:541-549.e5. [PMID: 26803570 DOI: 10.1016/j.jhsa.2015.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report our experience with intralesional curettage (resection with positive margins) and amputation (resection with negative margins) of low-grade chondrosarcomas (LCS) of the hand. MATERIALS AND METHODS Skeletally mature patients treated surgically for LCS of the hand at our institutions were reviewed. Demographics and oncological history were collected. Results of the entire cohort and by treatment modality were analyzed radiographically, functionally (strength, Disabilities of the Arm, Shoulder, and Hand measure), cosmetically, and oncologically (recurrence, Musculoskeletal Tumor Society score, metastasis, and mortality rates). RESULTS Seventeen cases in 16 patients were identified. Nine patients were women. Average age at surgery was 43 years (range, 20-80 years). Mean follow-up was 18 years (range, 9-23 years). Six of the 17 lesions treated at different institutions with intralesional procedures presented as recurrent disease. We treated 3 with a repeat intralesional procedure and the remaining with wide resection. Recurrence incidence was the same in both groups. The remaining 11 new-onset cases were treated with intralesional procedures (6) or wide resections (5). One of the 6 tumors treated with an intralesional procedure recurred. None treated with wide resection recurred. Recurrence incidence combining new- onset and recurrent disease after intralesional procedures was 22% versus 13% for wide resections. Average grip strength was 37 kg (range, 21-55 kg), and pinch strength was 7.6 kg (range, 4.5-12.5 kg). Mean Disabilities of the Arm, Shoulder, and Hand score was 2 (range, 0-10). There were no wound complications, and appearance was satisfactory in most cases (visual analog scale score, > 8). Average Musculoskeletal Tumor Society score was 29 points (range, 21-30 points). No patients presented with metastatic disease or died because of LCS. CONCLUSIONS Intralesional resections aiming to preserve function are safe, recognizing that more than 1 procedure may be required. Amputation also plays a role with excellent functional outcome in cases in which severe joint deformity or involvement of soft tissues and neurovascular structures interferes with function. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Juan González Del Pino
- Department of Orthopaedic Surgery, Division of Hand Surgery, Hospital Universitario Santa Cristina, Madrid, Spain
| | - Santiago A Lozano Calderón
- Department of Orthopaedic Surgery, Division of Musculoskeletal Oncology, Harvard Medical School, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Ivan Chebib
- James Homer Wright Pathology Laboratory, Massachusetts General Hospital, Boston, MA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Division of Hand Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Oh KY, Yoon HJ, Lee JI, Hong SP, Hong SD. Chondrosarcoma of the temporomandibular joint: a case report and review of the literature. Cranio 2016; 34:270-8. [PMID: 26088960 DOI: 10.1179/2151090315y.0000000016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Chondrosarcoma is the second most common sarcoma arising in the bone, but it rarely involves the temporomandibular joint (TMJ). To date, 30 cases of TMJ chondrosarcoma have been reported in the English literature, and the authors report an additional case arising from a cystic lesion in a 60-year-old female patient. CLINICAL PRESENTATION The clinical and radiological diagnosis of the lesion was initially synovial cyst, and periodic check-ups were done after aspiration of the lesion. After three years, the patient perceived swelling of the lesion, and surgical excision was performed. The final diagnosis was grade I chondrosarcoma. CONCLUSION When clinicians detect a cystic lesion in the radiographic imaging of the TMJ, chondrosarcoma should be included in the differential diagnosis. In addition, computed tomography (CT) as well as magnetic resonance imaging (MRI) is recommended for the accurate diagnosis and proper preoperative planning in TMJ chondrosarcoma.
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Affiliation(s)
- Kyu-Young Oh
- a Department of Oral Pathology, School of Dentistry and Dental Research Institute , Seoul National University , Seoul , Republic of Korea
| | - Hye-Jung Yoon
- a Department of Oral Pathology, School of Dentistry and Dental Research Institute , Seoul National University , Seoul , Republic of Korea
| | - Jae-Il Lee
- a Department of Oral Pathology, School of Dentistry and Dental Research Institute , Seoul National University , Seoul , Republic of Korea
| | - Sam-Pyo Hong
- a Department of Oral Pathology, School of Dentistry and Dental Research Institute , Seoul National University , Seoul , Republic of Korea
| | - Seong-Doo Hong
- a Department of Oral Pathology, School of Dentistry and Dental Research Institute , Seoul National University , Seoul , Republic of Korea
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Lohberger B, Leithner A, Stuendl N, Kaltenegger H, Kullich W, Steinecker-Frohnwieser B. Diacerein retards cell growth of chondrosarcoma cells at the G2/M cell cycle checkpoint via cyclin B1/CDK1 and CDK2 downregulation. BMC Cancer 2015; 15:891. [PMID: 26555773 PMCID: PMC4641423 DOI: 10.1186/s12885-015-1915-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/06/2015] [Indexed: 01/23/2023] Open
Abstract
Background Chondrosarcoma is characterized for its lack of response to conventional cytotoxic chemotherapy, propensity for developing lung metastases, and low rates of survival. Research within the field of development and expansion of new treatment options for unresectable or metastatic diseases is of particular priority. Diacerein, a symptomatic slow acting drug in osteoarthritis (SYSADOA), implicates a therapeutic benefit for the treatment of chondrosarcoma by an antitumor activity. Methods After treatment with diacerein the growth behaviour of the cells was analyzed with the xCELLigence system and MTS assay. Cell cycle was examined using flow cytometric analysis, RT-PCR, and western blot analysis of specific checkpoint regulators. The status for phosophorylation of mitogen-activated protein kinases (MAPKs) was analyzed with a proteome profiler assay. In addition, the possible impact of diacerein on apoptosis was investigated using cleaved caspase 3 and Annexin V/PI flow cytometric analysis. Results Diacerein decreased the cell viability and the cell proliferation in two different chondrosarcoma cell lines in a dose dependent manner. Flow cytometric analysis showed a classical G2/M arrest. mRNA and protein analysis revealed that diacerein induced a down-regulation of the cyclin B1-CDK1 complex and a reduction in CDK2 expression. Furthermore, diacerein treatment increased the phosphorylation of p38α and p38β MAPKs, and Akt1, Akt2, and Akt 3 in SW-1353, whereas in Cal-78 the opposite effect has been demonstrated. These observations accordingly to our cell cycle flow cytometric analysis and protein expression data may explain the G2/M phase arrest. In addition, no apoptotic induction after diacerein treatment, neither in the Cal-78 nor in the SW-1353 cell line was observed. Conclusions Our results demonstrate for the first time that the SYSADOA diacerein decreased the viability of human chondrosarcoma cells and induces G2/M cell cycle arrest by CDK1/cyclin B1 down-regulation.
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Affiliation(s)
- Birgit Lohberger
- Department of Orthopedic Surgery, Medical University Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
| | - Andreas Leithner
- Department of Orthopedic Surgery, Medical University Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
| | - Nicole Stuendl
- Department of Orthopedic Surgery, Medical University Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
| | - Heike Kaltenegger
- Department of Orthopedic Surgery, Medical University Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
| | - Werner Kullich
- Ludwig Boltzmann Institute for Rehabilitation of Internal Diseases, Ludwig Boltzmann Cluster for Rheumatology, Balneology and Rehabilitation, Saalfelden, Austria.
| | - Bibiane Steinecker-Frohnwieser
- Ludwig Boltzmann Institute for Rehabilitation of Internal Diseases, Ludwig Boltzmann Cluster for Rheumatology, Balneology and Rehabilitation, Saalfelden, Austria.
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Mundy C, Bello A, Sgariglia F, Koyama E, Pacifici M. HhAntag, a Hedgehog Signaling Antagonist, Suppresses Chondrogenesis and Modulates Canonical and Non-Canonical BMP Signaling. J Cell Physiol 2015; 231:1033-44. [DOI: 10.1002/jcp.25192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/10/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Christina Mundy
- Translational Research Program in Pediatric Orthopaedics; Division of Orthopaedic Surgery; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | | | - Federica Sgariglia
- Translational Research Program in Pediatric Orthopaedics; Division of Orthopaedic Surgery; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - Eiki Koyama
- Translational Research Program in Pediatric Orthopaedics; Division of Orthopaedic Surgery; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - Maurizio Pacifici
- Translational Research Program in Pediatric Orthopaedics; Division of Orthopaedic Surgery; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
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Reumann S, Shogren KL, Yaszemski MJ, Maran A. Inhibition of Autophagy Increases 2-Methoxyestradiol-Induced Cytotoxicity in SW1353 Chondrosarcoma Cells. J Cell Biochem 2015; 117:751-9. [DOI: 10.1002/jcb.25360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/01/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Stephan Reumann
- Department of Orthopedics; College of Medicine; Mayo Clinic Rochester, Minnesota 55905
- Paracelsus Medical University; Salzburg; Austria
| | - Kristen L. Shogren
- Department of Orthopedics; College of Medicine; Mayo Clinic Rochester, Minnesota 55905
| | - Michael J. Yaszemski
- Department of Orthopedics; College of Medicine; Mayo Clinic Rochester, Minnesota 55905
| | - Avudaiappan Maran
- Department of Orthopedics; College of Medicine; Mayo Clinic Rochester, Minnesota 55905
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Andreou D, Gilg MM, Gosheger G, Werner M, Hardes J, Pink D, Leithner A, Tunn PU, Streitbürger A. Metastatic Potential of Grade I Chondrosarcoma of Bone: Results of a Multi-institutional Study. Ann Surg Oncol 2015; 23:120-5. [PMID: 26350369 DOI: 10.1245/s10434-015-4852-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about the metastatic potential of low-grade chondrosarcoma. This study was designed to evaluate the rate of metastasis to identify possible risk factors. METHODS The files of 225 patients with newly diagnosed, grade I chondrosarcoma of bone treated between 1975 and 2012 were retrospectively analyzed. Median follow-up was 80 months for survivors (range 24-445 months). Nonparametric analyses were performed with the Mann-Whitney U test. Survival curves were calculated with the Kaplan-Meier method and compared with the log-rank test. RESULTS Fourteen patients developed metastases after a median of 49 months. Metastasis-free survival probability (MFS) was 95 % at 5 years and 92 % at 10 years. Post-metastasis survival probability amounted to 27 % after 5 years. Tumor size at diagnosis (P = 0.698) and surgical margin width (P = 0.514) had no influence on MFS. Patients who developed local recurrences had a significantly lower 10-year MFS than patients without recurrences (69 % vs. 99 %, P < 0.001). Patients with grade I recurrences had a significantly poorer MFS than patients without recurrences (P = 0.013) but a significantly higher MFS than patients with grade II recurrences (P = 0.006). Patients with thoracic wall tumors had a significantly lower 10-year MFS of 66 % compared with patients with tumors of the upper (100 %, P < 0.001) and lower extremity (93 %, P = 0.033). CONCLUSIONS The biological behavior of low-grade chondrosarcoma appears to be more consistent with the WHO definition of rarely metastasizing bone tumors, rather than the one of locally aggressive neoplasms. Thoracic wall tumors and the development of local recurrences were associated with a higher metastasis rate in this study.
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Affiliation(s)
- Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany.
| | - Magdalena M Gilg
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Mathias Werner
- Department of Pathology, Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Jendrik Hardes
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Daniel Pink
- Department of Hematology, Oncology and Palliative Care, Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Bad Saarow, Bad Saarow, Germany
| | - Andreas Leithner
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria
| | - Per-Ulf Tunn
- Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Arne Streitbürger
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
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83
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Nottrott M, Hardes J, Gosheger G, Andreou D, Henrichs M, Streitbuerger A. [Benign cartilage tumors. What should I do with incidental findings?]. Unfallchirurg 2015; 117:905-14. [PMID: 25274388 DOI: 10.1007/s00113-014-2578-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The majority of benign bone tumors are cartilage tumors. Most common are enchondroma and osteochondroma. Often they represent incidental findings in radiological diagnostics. Thus, the incidence of cartilage tumors is unknown, as most of them are never diagnosed due to the absence of any symptoms. OBJECTIVES This article describes the diagnostic and therapeutic approach of benign cartilage tumors, focusing on incidental findings. METHODS The current knowledge and our own experience in the diagnostics and treatment of benign condroid tumors are presented. RESULTS As enchondroma represent most often the classic incidental finding without any symptoms or clinical findings, osteochondroma are often diagnosed in young patients by clinical examination showing a painless swelling that can increase in size according to skeletal growth. Most of these asymptomatic enchondroma and osteochondroma are so called "leave me alone lesions" and do not need any treatment, while other benign tumors (e.g., atypical cartilage tumors, chondroblastoma, chondromyxoidfibroma or osteochondroma with a cartilage cap of over 2 cm) need surgical treatment. These active or local aggressive tumors must be differentiated from the "leave me alone lesions". Additionally, patients with syndromes like Ollier disease (enchondromatosis), Maffucci syndrome or hereditary multiple exostosis must be examined and checked carefully as malignant degradation is possible. CONCLUSION As most cartilage tumors are benign and remain benign, inappropriate diagnostics or operative treatment just to provide security is obsolete. Plain X-ray is often enough for follow-up and other modalities only become necessary when symptoms occur.
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Affiliation(s)
- M Nottrott
- Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland,
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84
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Outani H, Hamada K, Imura Y, Oshima K, Sotobori T, Demizu Y, Kakunaga S, Joyama S, Imai R, Okimoto T, Naka N, Kudawara I, Ueda T, Araki N, Kamada T, Yoshikawa H. Comparison of clinical and functional outcome between surgical treatment and carbon ion radiotherapy for pelvic chondrosarcoma. Int J Clin Oncol 2015; 21:186-93. [PMID: 26150259 DOI: 10.1007/s10147-015-0870-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND As there are no reports of studies in patients with pelvic chondrosarcoma treated with carbon ion radiotherapy (CIRT), the aim of this study was to evaluate the applicability of CIRT for patients with chondrosarcoma of the pelvis. METHODS The medical records of 31 patients with chondrosarcoma of the pelvis treated either by surgical resection or by CIRT between 1983 and 2014 were reviewed. There were 22 males and 9 females with a median age of 43 years (range 16-77 years). The median duration of follow-up was 66 months (range 5-289 months). Twenty-four patients underwent surgery, and 7 patients received CIRT (70.4 GyE in 16 fractions over 4 weeks). RESULTS The overall local recurrence rate was 32 %, and the estimated overall 5- and 10-year survival rates were 72 and 57 %, respectively. The mean Musculoskeletal Tumor Society functional score was 59 %. The treatment procedures (surgery or CIRT) did not affect overall survival (P = 0.347). However, the patients who underwent surgery had impaired function compared with those who received CIRT (P = 0.03). CONCLUSION Although more patients need to be monitored to assess the clinical and functional outcomes of CIRT for patients with chondrosarcoma of the pelvis, this treatment might offer an acceptable alternative.
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Affiliation(s)
- Hidetatsu Outani
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan.
| | - Kenichiro Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yoshinori Imura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazuya Oshima
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan
| | - Tsukasa Sotobori
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Shigeki Kakunaga
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Susumu Joyama
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan
| | - Reiko Imai
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Anagawa 4-9-1, Inage, Chiba, 263-8555, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ikuo Kudawara
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Nobuhito Araki
- Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka, 537-8511, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Anagawa 4-9-1, Inage, Chiba, 263-8555, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
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85
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Konishi E, Nakashima Y, Mano M, Tomita Y, Nagasaki I, Kubo T, Araki N, Haga H, Toguchida J, Ueda T, Sakuma T, Imahori M, Morii E, Yoshikawa H, Tsukamoto Y, Futani H, Wakasa K, Hoshi M, Hamada S, Takeshita H, Inoue T, Aono M, Kawabata K, Murata H, Katsura K, Urata Y, Ueda H, Yanagisawa A. Primary central chondrosarcoma of long bone, limb girdle and trunk: Analysis of 174 cases by numerical scoring on histology. Pathol Int 2015; 65:468-75. [PMID: 26126783 PMCID: PMC5557088 DOI: 10.1111/pin.12324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Abstract
The aims of this study were: (i) to elucidate clinicopathological characteristics of pcCHS of long bones (L), limb girdles (LG) and trunk (T) in Japan; (ii) to investigate predictive pathological findings for outcome of pcCHS of L, LG and T, objectively; and (iii) to elucidate a discrepancy of grade between biopsy and resected specimens. Clinicopathological profiles of 174 pcCHS (79 male, 95 female), of L, LG, and T were retrieved. For each case, a numerical score was given to 18 pathological findings. The average age was 50.5 years (15-80 years). Frequently involved sites were femur, humerus, pelvis and rib. The 5-year and 10-year disease-specific survival (DSS) rates [follow-up: 1-258 months (average 65.5)] were 87.0% and 80.4%, respectively. By Cox hazards analysis on pathological findings, age, sex and location, histologically higher grade and older age were unfavorable predictors, and calcification was a favorable predictor in DSS. The histological grade of resected specimen was higher than that of biopsy in 37.7% (26/69 cases). In conclusion, higher histological grade and older age were predictors for poor, but calcification was for good prognosis. Because there was a discrepancy in grade between biopsy and resected specimens, comprehensive evaluation is necessary before definitive operation for pcCHS.
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Affiliation(s)
- Eiichi Konishi
- Department of Pathology, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuaki Nakashima
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayuki Mano
- Department of Pathology, Osaka National Hospital, Osaka, Japan
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center of Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Ikumitsu Nagasaki
- Department of Mathematics, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuhito Araki
- Department of Orthopedic Surgery, Osaka Medical Center of Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Toguchida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan
| | - Toshiko Sakuma
- Department of Pathology, Hyogo Cancer Center, Akashi, Japan
| | - Masaya Imahori
- Department of Orthopedic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Hiroyuki Futani
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kenichi Wakasa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Masanari Aono
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kenji Kawabata
- Department of Pathology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Hiroaki Murata
- Department of Orthopedic Surgery, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Kanade Katsura
- Department of Pathology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yoji Urata
- Department of Pathology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Hideki Ueda
- Department of Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akio Yanagisawa
- Department of Pathology, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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86
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Kim HS, Bindiganavile SS, Han I. Oncologic outcome after local recurrence of chondrosarcoma: Analysis of prognostic factors. J Surg Oncol 2015; 111:957-61. [PMID: 26040553 DOI: 10.1002/jso.23925] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 04/04/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Literature on outcome after local recurrence (LR) in chondrosarcoma is scarce and better appreciation of prognostic factors is needed. OBJECTIVES (1) To evaluate post-LR oncologic outcomes of disease-specific survival and subsequent LR and (2) to identify prognostic factors for post-LR oncologic outcomes. PATIENTS AND METHODS Review of 28 patients with locally recurrent chondrosarcoma from the original cohort of 150 patients, who were treated surgically with or without adjuvants between 1982 and 2011, was performed. Mean age was 46 years (range, 21-73) which included 20 males and 8 females with mean follow up of 8.4 ± 7.5 years (range, 1.2-31.0). RESULTS Post-LR survival at 5 years was 58.6 ± 10.3%. Age greater than 50 years (P = 0.011) and LR occurring within 1 year of primary surgery (P = 0.011) independently predicted poor survival. Seven patients suffered subsequent LR, which was significantly affected by surgical margin for LR (P = 0.038). CONCLUSION Long-term survival of locally recurrent chondrosarcoma is achievable in a substantial number of patients. Older age at onset of LR and shorter interval from primary surgery to LR identifies high risk patients for poor post-LR survival while, wide surgical margins at LR surgery reduces the risk of subsequent LR.
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Affiliation(s)
- Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | | | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
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87
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Kim W, Han I, Kim EJ, Kang S, Kim HS. Outcomes of curettage and anhydrous alcohol adjuvant for low-grade chondrosarcoma of long bone. Surg Oncol 2015; 24:89-94. [PMID: 25912950 DOI: 10.1016/j.suronc.2015.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/02/2015] [Accepted: 04/04/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low-grade chondrosarcoma of long bones can be treated successfully with extended intralesional curettage using adjuvants. However, there is no study reporting the use of anhydrous alcohol as an adjuvant in the treatment of low-grade chondrosarcoma. We asked (1) whether intralesional curettage and anhydrous alcohol adjuvant for low-grade chondrosarcoma is associated with good oncologic outcomes; and we report (2) the complications of the procedure. METHODS Thirty-six patients (13 men, 23 women) with a mean age of 46 years (range, 18-67 years) were treated for low-grade chondrosarcoma and followed up for a median of 62 months (range, 24-169 months). After intralesional curettage, and additional burring, anhydrous alcohol was used as an adjuvant therapy. RESULTS At the time of last follow-up, there were no local recurrences or distant metastases. Six patients developed complications: 4 postoperative fractures (11%), 1 intra-articular loose body (3%) and 1 postoperative joint stiffness (3%). CONCLUSION Anhydrous alcohol is a reasonable adjuvant for the curettage of low-grade chondrosarcoma of long bones. A long-term follow-up study is necessary, considering the slow biological progression of low-grade chondrosarcoma.
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Affiliation(s)
- Wanlim Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, South Korea.
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, South Korea; Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, South Korea.
| | - Eo Jin Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, South Korea.
| | - Seungcheol Kang
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, South Korea.
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, South Korea; Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, South Korea.
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88
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Provenzano S, Hindi N, Morosi C, Ghilardi M, Collini P, Casali PG, Stacchiotti S. Response of conventional chondrosarcoma to gemcitabine alone: a case report. Clin Sarcoma Res 2015; 5:9. [PMID: 25793102 PMCID: PMC4365557 DOI: 10.1186/s13569-015-0025-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/03/2015] [Indexed: 01/06/2023] Open
Abstract
Conventional skeletal chondrosarcoma is a bone neoplasm, which is poorly sensitive to anthracyclines-based chemotherapy. We report on an 18-month-long tumour response to gemcitabine as single agent in a young patient with an advanced secondary peripheral conventional chondrosarcoma, previously treated unsuccessfully with anthracyclines, ifosfamide, platinum, etoposide.
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Affiliation(s)
- Salvatore Provenzano
- />Adult mesenchymal tumour & Rare cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1 I-20133 Milan, Italy
| | - Nadia Hindi
- />Adult mesenchymal tumour & Rare cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1 I-20133 Milan, Italy
| | - Carlo Morosi
- />Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mara Ghilardi
- />Medical Oncology Unit, Ospedale di Treviglio, Azienda Ospedaliera Treviglio, Treviglio, (BG) Italy
| | - Paola Collini
- />Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo G Casali
- />Adult mesenchymal tumour & Rare cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1 I-20133 Milan, Italy
| | - Silvia Stacchiotti
- />Adult mesenchymal tumour & Rare cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, via G. Venezian, 1 I-20133 Milan, Italy
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89
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Tinoco G, Wilky BA, Paz-Mejia A, Rosenberg A, Trent JC. The biology and management of cartilaginous tumors: a role for targeting isocitrate dehydrogenase. Am Soc Clin Oncol Educ Book 2015:e648-e655. [PMID: 25993236 DOI: 10.14694/edbook_am.2015.35.e648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chondrosarcomas are rare mesenchymal neoplasms defined by the production of abnormal cartilaginous matrix. Conventional chondrosarcoma is the most common histology. The management of primary conventional chondrosarcoma generally is surgical with the possible addition of radiation therapy. Treatment of conventional chondrosarcoma is problematic in unresectable or metastatic disease because the tumors tend to be resistant to standard sarcoma chemotherapy regimens. Previous attempts at targeted therapy, including inhibitors of Hedgehog signaling, the mTOR pathway, and platelet-derived growth factor receptor (PDGFR) have been largely disappointing. However, heterozygous mutations in isocitrate dehydrogenase (IDH) enzymes recently have been identified in chondrogenic neoplasms, with mutations reported in approximately 87% of benign enchondromas, 70% of conventional chondrosarcomas, and 54% of dedifferentiated chondrosarcomas. The normal IDH protein continues to produce alpha-ketoglutarate (alpha-KG) whereas the mutant IDH protein converts KG to the oncometabolite 2-hydroxyglutarate (2-HG). Clinical trials of novel IDH inhibitors are ongoing, with evidence of early activity in IDH-mutant leukemias. IDH inhibitors show antitumor effects against IDH-mutant chondrosarcoma cell lines, supporting the inclusion of patients with chondrosarcoma with IDH mutations on IDH inhibitor clinical trials for solid tumors. Targeting IDH mutations may offer hope of a novel antineoplastic strategy not only for patients with chondrosarcomas, but also for other solid tumors with aberrant IDH activity.
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Affiliation(s)
- Gabriel Tinoco
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Breelyn A Wilky
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Ana Paz-Mejia
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Andrew Rosenberg
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
| | - Jonathan C Trent
- From the Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL
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90
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Mermerkaya MU, Bekmez S, Karaaslan F, Danisman M, Kosemehmetoglu K, Gedikoglu G, Ayvaz M, Tokgozoglu AM. Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review. World J Surg Oncol 2014; 12:336. [PMID: 25382793 PMCID: PMC4246483 DOI: 10.1186/1477-7819-12-336] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/20/2014] [Indexed: 12/16/2022] Open
Abstract
Background Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate. Methods We performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012. Results The average age of the patients was 48.7 (range, 18–71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26–85) months after surgery. The treated lesions were located in the proximal humerus (n =10), proximal tibia (n =6), and distal femur (n =5). At the average follow-up time point of 58.4 (range, 26–85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84–100). Conclusions The combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.
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91
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Xiang W, Jiang T, Guo F, Xu T, Gong C, Cheng P, Zhao L, Cheng W, Xu K. Evaluating the role of PTH in promotion of chondrosarcoma cell proliferation and invasion by inhibiting primary cilia expression. Int J Mol Sci 2014; 15:19816-31. [PMID: 25365173 PMCID: PMC4264140 DOI: 10.3390/ijms151119816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/15/2014] [Accepted: 10/23/2014] [Indexed: 01/28/2023] Open
Abstract
Chondrosarcoma is characterized by secretion of a cartilage-like matrix, with high proliferation ability and metastatic potential. Previous studies have shown that parathyroid hormone-related protein (PTHrP) has a close relationship with various tumor types. The objectives of this study were to research the function played by PTHrP in human chondrosarcoma, especially targeting cell proliferation and invasion, and to search for the potential interaction between PTHrP and primary cilia in tumorigenesis. Surgical resection tissues and the human chondrosarcoma cell line SW1353 were used in the scientific research. Cells were stimulated with an optimum concentration of recombinant PTH (1-84), and siRNA was used to interfere with internal PTHrP. Cell proliferation and invasion assays were applied, including MTS-8 cell proliferation assay, Western blot, RT-PCR, Transwell invasion assay, and immunohistochemistry and immunofluorescence assays. A high level of PTHrP expression was found in human chondrosarcoma tissues, and recombinant PTH exhibited positive promotion in tumor cell proliferation and invasion. In the meantime, PTHrP could inhibit the assembly of primary cilia and regulate downstream gene expression. These findings indicate that PTHrP can regulate tumor cell proliferation and invasion ability, possibly through suppression of primary cilia assembly. Thus, restricting PTHrP over-expression is a feasible potential therapeutic method for chondrosarcoma.
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Affiliation(s)
- Wei Xiang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Ting Jiang
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Fengjing Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Tao Xu
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Chen Gong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Peng Cheng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Libo Zhao
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Weiting Cheng
- Department of Oncology, Wuhan Integrated Traditional Chinese Medicine and Western Medicine Hospital, Wuhan No1. Hospital, Wuhan 430030, China.
| | - Kai Xu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Brown MT, Gikas PD, Bhamra JS, Skinner JA, Aston WJS, Pollock RC, Saifuddin A, Briggs TWR. How safe is curettage of low-grade cartilaginous neoplasms diagnosed by imaging with or without pre-operative needle biopsy? Bone Joint J 2014; 96-B:1098-105. [PMID: 25086127 DOI: 10.1302/0301-620x.96b8.32056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pre-operative differentiation between enchondroma, low-grade chondrosarcoma and high-grade chondrosarcoma remains a diagnostic challenge. We reviewed the accuracy and safety of the radiological grading of cartilaginous tumours through the assessment of, first, pre-operative radiological and post-operative histological agreement, and second the rate of recurrence in lesions confirmed as high-grade on histology. We performed a retrospective review of major long bone cartilaginous tumours managed by curettage as low grade between 2001 and 2012. A total of 53 patients with a mean age of 47.6 years (8 to 71) were included. There were 23 men and 30 women. The tumours involved the femur (n = 20), humerus (n = 18), tibia (n = 9), fibula (n = 3), radius (n = 2) and ulna (n = 1). Pre-operative diagnoses resulted from multidisciplinary consensus following radiological review alone for 35 tumours, or with the addition of pre-operative image guided needle biopsy for 18. The histologically confirmed diagnosis was enchondroma for two (3.7%), low-grade chondrosarcoma for 49 (92.6%) and high-grade chondrosarcoma for two (3.7%). Three patients with a low-grade tumour developed a local recurrence at a mean of 15 months (12 to 17) post-operatively. A single high-grade recurrence (grade II) was treated with tibial diaphyseal replacement. The overall recurrence rate was 7.5% at a mean follow-up of 4.7 years (1.2 to 12.3). Cartilaginous tumours identified as low-grade on pre-operative imaging with or without additional image-guided needle biopsy can safely be managed as low-grade without pre-operative histological diagnosis. A few tumours may demonstrate high-grade features histologically, but the rates of recurrence are not affected.
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Affiliation(s)
- M T Brown
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - P D Gikas
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - J S Bhamra
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - J A Skinner
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - W J S Aston
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - R C Pollock
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - A Saifuddin
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - T W R Briggs
- Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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93
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Hedgehog pathway inhibitor-4 suppresses malignant properties of chondrosarcoma cells by disturbing tumor ciliogenesis. Oncol Rep 2014; 32:1622-30. [PMID: 25110171 DOI: 10.3892/or.2014.3372] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/08/2014] [Indexed: 11/05/2022] Open
Abstract
Chondrosarcoma is a type of malignant bone tumor secreting cartilage-like matrix. In clinical treatment, there is no frequently used drug treatment option except for surgical resection. Hedgehog (HH) pathway is a classical signaling pathway that regulates normal cartilage cell development. In order to detect the role that HH pathway plays in chondrosarcoma, we used immunohistochemistry and found this tumor clearly expressed HH pathway-related proteins. Treatment with HH pathway inhibitor-4 (HPI-4) could significantly decrease human chondrosarcoma cell proliferation, invasion and migration ability. Furthermore, HPI-4 could distinctly disturb HH pathway-mediated ciliogenesis and suppress primary cilia-related protein intraflagellar transport protein IFT88 expression. HH downstream effect molecular GLI2 was restrained to block parathyroid hormone-related protein and affect MAPK/ERK-regulated matrix metalloproteinases (MMP2 and MMP9). These results indicated that activated HH pathway existed in chondrosarcoma and HPI-4 could be a new therapeutic option specific to chondrosarcoma expressing elevated levels of HH pathway.
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Abstract
Chondrosarcoma is a cartilage forming neoplasm, which is the second most common primary malignancy of bone. Clinicians who treat chondrosarcoma patients must determine the grade of the tumor, and must ascertain the likelihood of metastasis. Acral lesions are unlikely to metastasize, regardless of grade, whereas axial, or more proximal lesions are much more likely to metastasize than tumors found in the distal extremities with equivalent histology. Chondrosarcoma is resistant to both chemotherapy and radiation, making wide local excision the only treatment. Local recurrence is frequently seen after intralesional excision, thus wide local excision is sometimes employed despite significant morbidity, even in low-grade lesions. Chondrosarcoma is difficult to treat. The surgeon must balance the risk of significant morbidity with the ability to minimize the chance of local recurrence and maximize the likelihood of long-term survival.
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Affiliation(s)
- Lee R Leddy
- Medical University of South Carolina, Charleston, SC, USA,
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95
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Novel strategies for the treatment of chondrosarcomas: targeting integrins. BIOMED RESEARCH INTERNATIONAL 2013; 2013:396839. [PMID: 24490159 PMCID: PMC3893802 DOI: 10.1155/2013/396839] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/09/2013] [Indexed: 12/29/2022]
Abstract
Chondrosarcomas are a heterogeneous group of malignant bone tumors that are characterized by the production of cartilaginous extracellular matrix. They are the second most frequently occurring type of bone malignancy. Surgical resection remains the primary mode of treatment for chondrosarcomas, since conventional chemotherapy and radiotherapy are largely ineffective. Treatment of patients with high-grade chondrosarcomas is particularly challenging, owing to the lack of effective adjuvant therapies. Integrins are cell surface adhesion molecules that regulate a variety of cellular functions. They have been implicated in the initiation, progression, and metastasis of solid tumors. Deregulation of integrin expression and/or signaling has been identified in many chondrosarcomas. Therefore, the development of new drugs that can selectively target regulators of integrin gene expression and ligand-integrin signaling might hold great promise for the treatment of these cancers. In this review, we provide an overview of the current understanding of how growth factors, chemokines/cytokines, and other inflammation-related molecules can control the expression of specific integrins to promote cell migration. We also review the roles of specific subtypes of integrins and their signaling mechanisms, and discuss how these might be involved in tumor growth and metastasis. Finally, novel therapeutic strategies for targeting these molecules will be discussed.
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96
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Dierselhuis EF, Stevens M, Jutte PC. Intralesional treatment versus wide resection for central chondrosarcoma grade I in the long bones. Hippokratia 2013. [DOI: 10.1002/14651858.cd010778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Edwin F Dierselhuis
- University Medical Center Groningen; Department of Orthopaedic Surgery; Hanzeplein 1 Groningen Netherlands 9700
| | - Martin Stevens
- University Medical Center Groningen; Department of Orthopaedic Surgery; Hanzeplein 1 Groningen Netherlands 9700
| | - Paul C Jutte
- University Medical Center Groningen; Department of Orthopaedic Surgery; Hanzeplein 1 Groningen Netherlands 9700
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97
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Huegel J, Sgariglia F, Enomoto-Iwamoto M, Koyama E, Dormans JP, Pacifici M. Heparan sulfate in skeletal development, growth, and pathology: the case of hereditary multiple exostoses. Dev Dyn 2013; 242:1021-32. [PMID: 23821404 DOI: 10.1002/dvdy.24010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 12/14/2022] Open
Abstract
Heparan sulfate (HS) is an essential component of cell surface and matrix-associated proteoglycans. Due to their sulfation patterns, the HS chains interact with numerous signaling proteins and regulate their distribution and activity on target cells. Many of these proteins, including bone morphogenetic protein family members, are expressed in the growth plate of developing skeletal elements, and several skeletal phenotypes are caused by mutations in those proteins as well as in HS-synthesizing and modifying enzymes. The disease we discuss here is hereditary multiple exostoses (HME), a disorder caused by mutations in HS synthesizing enzymes EXT1 and EXT2, leading to HS deficiency. The exostoses are benign cartilaginous-bony outgrowths, form next to growth plates, can cause growth retardation and deformities, chronic pain and impaired motion, and progress to malignancy in 2-5% of patients. We describe recent advancements on HME pathogenesis and exostosis formation deriving from studies that have determined distribution, activities and roles of signaling proteins in wild-type and HS-deficient cells and tissues. Aberrant distribution of signaling factors combined with aberrant responsiveness of target cells to those same factors appear to be a major culprit in exostosis formation. Insights from these studies suggest plausible and cogent ideas about how HME could be treated in the future.
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Affiliation(s)
- Julianne Huegel
- Translational Research Program in Pediatric Orthopaedics, Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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Jiang B, Veeravagu A, Feroze AH, Lee M, Harsh GR, Soltys SG, Gibbs IC, Adler JR, Chang SD. CyberKnife radiosurgery for the management of skull base and spinal chondrosarcomas. J Neurooncol 2013; 114:209-18. [DOI: 10.1007/s11060-013-1172-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/26/2013] [Indexed: 12/31/2022]
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99
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Mavrogenis AF, Angelini A, Drago G, Merlino B, Ruggieri P. Survival analysis of patients with chondrosarcomas of the pelvis. J Surg Oncol 2013; 108:19-27. [DOI: 10.1002/jso.23351] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 04/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Andreas F. Mavrogenis
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
| | - Andrea Angelini
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
| | - Gabriele Drago
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
| | - Biagio Merlino
- The Department of Radiology; Catholic University; Rome Italy
| | - Pietro Ruggieri
- Department of Orthopaedics, The Istituto Ortopedico Rizzoli; University of Bologna; Bologna Italy
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100
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Aponte-Tinao LA, Ritacco LE, Ayerza MA, Muscolo DL, Farfalli GL. Multiplanar osteotomies guided by navigation in chondrosarcoma of the knee. Orthopedics 2013; 36:e325-30. [PMID: 23464952 DOI: 10.3928/01477447-20130222-21] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical resection with adequate margins is the treatment of choice in chondrosarcoma. However, well-circumscribed lesions can be completely resected by performing multi-planar osteotomies guided by computer-assisted navigation. This type of resection had been recently described in select patients with sarcomas; however, these osteotomies are technically demanding to plan and perform intraoperatively. The use of navigation to assist in surgery is becoming more frequently described in orthopedic oncology.The authors performed multiplanar osteotomy resections guided by navigation and reconstruction with intercalary allografts in 5 patients with chondrosarcoma around the knee. All the patients were women, with a mean age of 56 years. Four tumors were located in the distal femur and 1 in the proximal tibia. The 5 surgical anatomic specimens were 3-dimensionally reconstructed postoperatively and superimposed on a preoperative plan to check whether the resected specimen was consistent with the preoperative planned resection. At final follow-up, no patient experienced a local recurrence or metastasis. Four osteotomies each were performed in 3 patients, and 3 osteotomies each were performed in 2 patients, so 18 planes were evaluated. Mean difference in distance between preoperative vs final planes was 2.43 mm. Average functional score was 29 points. All patients resumed activities of daily living without restriction. This study's results show that navigation with adequate preoperative planning allows surgeons to intraoperatively reproduce the planned resection with accuracy in complex multiplanary resections.
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Affiliation(s)
- Luis A Aponte-Tinao
- Institute of Orthopedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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