1
|
Deckers C, de Leijer EM, Flucke U, de Rooy JWJ, Schreuder HWB, Dierselhuis EF, van der Geest ICM. Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series. J Surg Oncol 2021; 123:1821-1827. [PMID: 33713465 PMCID: PMC8251520 DOI: 10.1002/jso.26457] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Intralesional surgical treatment is the preferred therapy for atypical cartilaginous tumors (ACTs) of the long bones in many institutions. However, the literature is still controversial regarding intralesional treatment versus wide resection. Due to the relative rarity of these tumors, studies reporting on the results of intralesional treatment are often small sample studies. METHODS We retrospectively analyzed the oncological results of 55 enchondromas, 119 ACTs, and 5 chondrosarcomas grade 2 (CS2) treated with curettage and cryosurgery between the years 2004 and 2017 at our institution. The median follow-up period was 53 months (range, 24-169 months). RESULTS In total, seven cases (three ACT, four CS2) recurred. Residual tumor was detected in 20 cases. Three cases underwent secondary curettage and cryosurgery due to local recurrence. Four cases underwent wide resection and reconstruction due to local recurrence with aggressive imaging characteristics. In total, 20 postoperative complications were seen. CONCLUSION Curettage and cryosurgery for enchondroma and ACT show very good oncological results with a low recurrence rate and acceptable complication rate. Curettage and cryosurgery is reliable as a surgical treatment for enchondroma and ACT. Further research should define the criteria for determining which specific cartilaginous tumors necessitate surgical treatment.
Collapse
Affiliation(s)
- Claudia Deckers
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther M de Leijer
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Uta Flucke
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacky W J de Rooy
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H W Bart Schreuder
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edwin F Dierselhuis
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
2
|
Saifuddin A, Oliveira I, Singla N, Chavda A, Khoo M, O'Donnell P. The importance of MRI review following the diagnosis of atypical cartilaginous tumour using image-guided needle biopsy. Skeletal Radiol 2021; 50:407-415. [PMID: 32794057 DOI: 10.1007/s00256-020-03578-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the role of pre-biopsy MRI for management planning in patients with atypical cartilaginous tumours (ACT) diagnosed on image-guided core needle biopsy (IGCNB). MATERIALS AND METHODS Retrospective review of patients diagnosed with ACT of the appendicular skeleton based on IGCNB who subsequently underwent surgical curettage or resection. Data collected included age, sex, skeletal location and surgical histology classified as ACT, high-grade chondrosarcoma (HG-CS) and dedifferentiated chondrosarcoma (DD-CS). Pre-biopsy MRI studies were reviewed independently by 2 radiologists blinded to surgical histology results and graded as ACT, HG-CS and DD-CS based on MRI features. RESULTS The study included 24 males and 28 females (mean age 42.1 years; range 9-76 years). One patient had 2 lesions treated, making a total of 53 lesions. Tumours were located in the femur in 21 cases, humerus in 17, tibia in 9, radius in 4 and ulna and fibula in 1 each. Surgical histology was ACT in 41 cases, HG-CS in 10 and DD-CS in 2, indicating mismatch between IGCNB and surgical histology in 12/53 cases (22.6%). Predicted MRI grade for the 2 readers was ACT in 39 cases each, HG-CS in 13 and 14 cases and DD-CS in 1 and 0 cases. Sensitivity, specificity and accuracy of MRI for predicting HG-CS/DD-CS were 91%, 93% and 92%, respectively. Inter-observer correlation was very good (kappa = 0.94). DISCUSSION Review of MRI findings in patients with ACT diagnosed on IGCNB is vital for identifying patients with a HG-CS/DD-CS and is recommended when planning surgical management or considering repeat IGCNB.
Collapse
Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Ines Oliveira
- Department of Radiology, London North West Healthcare NHS Trust, London, UK
| | - Nehal Singla
- Department of Radiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anesh Chavda
- Department of Radiology, West Middlesex University Hospital and Chelsea and Westminster Hospital, London, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Paul O'Donnell
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.,Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| |
Collapse
|
3
|
Bickels J, Campanacci DA. Local Adjuvant Substances Following Curettage of Bone Tumors. J Bone Joint Surg Am 2020; 102:164-174. [PMID: 31613863 DOI: 10.2106/jbjs.19.00470] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jacob Bickels
- Unit of Orthopedic Oncology, Orthopedic Division, Hillel-Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, The Technion, Israel
| | - Domenico A Campanacci
- Unit of Orthopaedic Oncology, Department of Health Sciences, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| |
Collapse
|
4
|
Stevenson JD, Laitinen MK, Parry MC, Sumathi V, Grimer RJ, Jeys LM. The role of surgical margins in chondrosarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1412-1418. [DOI: 10.1016/j.ejso.2018.05.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/10/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022]
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
The Identification of Prognostic Factors and Survival Statistics of Conventional Central Chondrosarcoma. Sarcoma 2015; 2015:623746. [PMID: 26633939 PMCID: PMC4655064 DOI: 10.1155/2015/623746] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction. Chondrosarcomas are malignant bone tumors that are characterized by the production of chondroid tissue. Since radiation therapy and chemotherapy have limited effect on chondrosarcoma, treatment of most patients depends on surgical resection. We conducted this study to identify independent predictive factors and survival characteristics for conventional central chondrosarcoma and dedifferentiated central chondrosarcoma. Methods. A systematic literature review was performed in September 2014 using the Pubmed, Embase, and Cochrane databases. Subsequent to a beforehand-composed selection procedure we included 13 studies, comprising a total of 1114 patients. Results. The prognosis of central chondrosarcoma is generally good for the histologically low-grade tumors. Prognosis for the high-grade chondrosarcoma and the dedifferentiated chondrosarcoma is poor with lower survival rates. Poor prognostic factors in conventional chondrosarcoma for overall survival are high-grade tumors and axial/pelvic tumor location. In dedifferentiated chondrosarcoma the percentage of dedifferentiated component has significant influence on disease-free survival. Conclusion. Despite the fact that there are multiple prognostic factors identified, as shown in this study, there is a need for prospective and comparative studies. The resulting knowledge about prognostic factors and survival can give direction in the development of better therapies. This could eventually lead to an evidence-based foundation for treating chondrosarcoma patients.
Collapse
|
7
|
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
| |
Collapse
|
8
|
Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton. J Orthop Traumatol 2013; 14:101-7. [PMID: 23462877 PMCID: PMC3667363 DOI: 10.1007/s10195-013-0230-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/31/2013] [Indexed: 11/21/2022] Open
Abstract
Background Diagnosis and treatment of low-grade chondrosarcoma remain controversial. We performed a review of a single-center series with the aims of assessing the oncologic outcome of these patients, verifying if intralesional curettage can be adequate treatment, and defining clinical criteria to support the surgeon and the oncologist in decision-making for surgery and subsequent follow-up. Materials and methods A retrospective review of 85 patients was performed (61 females and 24 males, age range 20–76 years). The site of the lesion was the femur in 35 cases, humerus in 33, tibia in 15, and fibula in 2. Sixty-four patients were treated by intralesional curettage. Twenty-one patients with aggressive radiological patterns were treated with wide resection. Results Mean follow-up was 67 months (range 24–206 months). Two patients developed local recurrence, both after intralesional curettage. The difference in incidence of recurrence was not statistically significant between the two groups. No distant metastases were observed. Postsurgical complications were significantly higher in the resection group. Conclusions Low-grade chondrosarcoma of the appendicular skeleton without aggressive radiological patterns can be treated with intralesional surgery with good oncological outcome and very low rate of postsurgical complications. Wide resection, following surgical principles of malignant bone tumors, should be considered only when aggressive biologic behavior is evident on imaging.
Collapse
|