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Archives of Orthopaedic and Trauma Surgery

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01-07-2018 | Orthopaedic Surgery

Intralesional vs. extralesional procedures for low-grade central chondrosarcoma: a systematic review of the literature

Authors: Carmine Zoccali, Jacopo Baldi, Dario Attala, Barbara Rossi, Vincenzo Anelli, Alessio Annovazzi, Virginia Ferraresi

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2018

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.

Ahmed AR, Tan TS, Unni KK, Collins MS, Wenger DE, Sim FH (2003) Secondary chondrosarcoma in osteochondroma: report of 107 patients. Clin Orthop Relat Res 411:193–206CrossRef

Altay M, Bayrakci K, Yildiz Y, Erekul S, Saglik Y (2007) Secondary chondrosarcoma in cartilage bone tumors: report of 32 patients. J Orthop Sci 12:415–423CrossRefPubMed

Gitelis S, Bertoni F, Picci P, Campanacci M (1981) Chondrosarcoma of bone. The experience at the Istituto Ortopedico Rizzoli. J Bone Jt Surg Am 63(8):1248–1257CrossRef

Guide Line SIOT Study Group (2011) La diagnosi e il trattamento del condrosarcoma. GIOT 37:18–26

Evans HL, Ayala AG, Romsdahl MM (1977) Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer 40:818–831CrossRefPubMed

Eefting D, Schrage YM, Geirnaerdt MJ, Le Cessie S, Taminiau AH, Bove`e JV, Hogendoorn PC (2009) EuroBoNet consortium. Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol 33(1):50–57CrossRefPubMed

Fletcher CD, Bridge JA, Hongendroorn PC, Mertens F (eds) (2013) WHO classification of tumours and soft tissue and bone. WHO, Lyon

Gelderblom H, Hogendoorn PC, Dijkstra SD, van Rijswijk CS, Krol AD, Taminiau AH, Bovée JV (2008) The clinical approach towards chondrosarcoma. Oncologist 13(3):320–329CrossRefPubMed

Riedel RF, Larrier N, Dodd L, Kirsch D, Martinez S, Brigman BE (2009) The clinical management of chondrosarcoma. Curr Treat Options Oncol 10(1–2):94–106CrossRefPubMed

10.

Campanacci DA, Scoccianti G, Franchi A, Roselli G, Beltrami G, Ippolito M, Caff G, Frenos F, Capanna R (2013) Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton. J OrthopTraumatol 14(2):101–107

11.

Gunay C, Atalar H, Hapa O, Basarir K, Yildiz Y, Saglik Y (2013) Surgical management of grade I chondrosarcoma of the long bones. Acta Orthop Belg 79(3):331–337PubMed

12.

Chow WA (2007) Update on chondrosarcomas. Curr Opin Oncol 19(4):371–376CrossRefPubMed

13.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reportingb cxsystematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMedPubMedCentral

14.

Chen YC, Wu PK, Chen CF, Chen WM (2017) Intralesional curettage of central low-grade chondrosarcoma: a midterm follow-up study. J Chin Med Assoc 80(3):178–182 (44) CrossRefPubMed

15.

Brown MT, Gikas PD, Bhamra JS, Skinner JA, Aston WJ, Pollock RC, Saifuddin A, Briggs TW (2014) How safe is curettage of low-grade cartilaginous neoplasms diagnosed by imaging with or without pre-operative needle biopsy? Bone Jt J 96-B(8):1098–1105CrossRef

16.

Verdegaal SH, Brouwers HF, van Zwet EW, Hogendoorn PC, Taminiau AH (2012) Low-grade chondrosarcoma of long bones treated with intralesional curettage followed by application of phenol, ethanol, and bone-grafting. J Bone Jt Surg Am 94(13):1201–1207CrossRef

17.

Angelini A, Guerra G, Mavrogenis AF, Pala E, Picci P, Ruggieri P (2012) Clinical outcome of central conventional chondrosarcoma. J Surg Oncol 106(8):929–937CrossRefPubMed

18.

Funovics PT, Panotopoulos J, Sabeti-Aschraf M, Abdolvahab F, Funovics JM, Lang S, Kotz RI, Dominkus M (2011) Low-grade chondrosarcoma of bone: experiences from the Vienna Bone and Soft Tissue Tumour Registry. Int Orthop 35(7):1049–1056CrossRefPubMed

19.

Mohler DG, Chiu R, McCall DA, Avedian RS (2010) Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function. Clin Orthop Relat Res 468(10):2765–2773CrossRefPubMedPubMedCentral

20.

Leerapun T, Hugate RR, Inwards CY, Scully SP, Sim FH (2007) Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop Relat Res 463:166–172PubMed

21.

Andreou D, Ruppin S, Fehlberg S, Pink D, Werner M, Tunn PU (2011) Survival and prognostic factors in chondrosarcoma: results in 115 patients with long-term follow-up. Acta Orthop 82(6):749–755CrossRefPubMedPubMedCentral

22.

Van der Geest IC, de Valk MH, de Rooy JW, Pruszczynski M, Veth RP, Schreuder HW (2008) Oncological and functional results of cryosurgical therapy of enchondromas and chondrosarcomas grade 1. J Surg Oncol 98(6):421–426CrossRefPubMed

23.

Björnsson J, McLeod RA, Unni KK, Ilstrup DM, Pritchard DJ (1998) Primary chondrosarcoma of long bones and limb girdles. Cancer 83(10):2105–2119CrossRefPubMed

24.

Schreuder HW, Pruszczynski M, Veth RP, Lemmens JA (1998) Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery. Eur J Surg Oncol 24(2):120–126CrossRefPubMed

25.

Etchebehere M, de Camargo OP, Croci AT, Oliveira CR, Baptista AM (2005) Relationship between surgical procedure and outcome for patients with grade I chondrosarcomas. Clinics (Sao Paulo) 60(2):121–126CrossRef

26.

Streitbürger A, Ahrens H, Balke M, Buerger H, Winkelmann W, Gosheger G, Hardes J (2009) Grade I chondrosarcoma of bone: the Münster experience. J Cancer Res Clin Oncol 135(4):543–550CrossRefPubMed

27.

Pring ME, Weber KL, Unni KK, Sim FH (2001) Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Jt Surg Am 83-A(11):1630–1642CrossRef

28.

Sheth DS, Yasko AW, Johnson ME, Ayala AG, Murray JA, Romsdahl MM (1996) Chondrosarcoma of the pelvis. Prognostic factors for 67 patients treated with definitive surgery. Cancer 78(4):745–750CrossRefPubMed

29.

Berber O, Datta G, Sabharwal S, Aston W, Saifuddin A, Briggs T (2012) The safety of direct primary excision of low-grade chondral lesions based on radiological diagnosis alone. Acta Orthop Belg 78(2):254–262PubMed

30.

Giuffrida AY, Burgueno JE, Koniaris LG, Gutierrez JC, Duncan R, Scully SP (2009) Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Jt Surg Am 91(5):1063–1072CrossRef

31.

Normand AN, Cannon CP, Lewis VO, Lin PP, Yasko AW (2007) Curettage of biopsy-diagnosed grade 1 periacetabular chondrosarcoma. Clin Orthop Relat Res 459:146–149CrossRefPubMed

32.

Dierselhuis EF, Gerbers JG, Ploegmakers JJ, Stevens M, Suurmeijer AJ, Jutte PC (2016) Local treatment with adjuvant therapy for central atypical cartilaginous tumors in the long bones: analysis of outcome and complications in one hundred and eight patients with a minimum follow-up of two years. J Bone Jt Surg Am 98(4):303–313CrossRef

33.

Ma XJ, Dong Y, Zhang CL, Zeng BF (2009) Recurrence analysis in 66 cases with grade I and grade II chondrosarcomas in the extremities. Orthop Surg 1(2):132–136CrossRefPubMed

34.

Rizzo M, Ghert MA, Harrelson JM, Scully SP (2001) Chondrosarcoma of bone: analysis of 108 cases and evaluation for predictors of outcome. Clin Orthop Relat Res 391:224–233CrossRef

35.

Hanna SA, Whittingham-Jones P, Sewell MD, Pollock RC, Skinner JA, Saifuddin A, Flanagan A, Cannon SR, Briggs TW (2009) Outcome of intralesional curettage for low-grade chondrosarcoma of long bones. Eur J Surg Oncol 35(12):1343–1347CrossRefPubMed

36.

Kim W, Han I, Kim EJ, Kang S, Kim HS (2015) Outcomes of curettage and anhydrous alcohol adjuvant for low-grade chondrosarcoma of long bone. Surg Oncol 24(2):89–94CrossRefPubMed

37.

Mermerkaya MU, Bekmez S, Karaaslan F, Danisman M, Kosemehmetoglu K, Gedikoglu G, Ayvaz M, Tokgozoglu AM (2014) Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review. World J Surg Oncol 12:336CrossRefPubMedPubMedCentral

38.

Meftah M, Schult P, Henshaw RM (2013) Long-term results of intralesional curettage and cryosurgery for treatment of low-grade chondrosarcoma. J Bone Jt Surg Am 95(15):1358–1364CrossRef

39.

Di Giorgio L, Touloupakis G, Vitullo F, Sodano L, Mastantuono M, Villani C (2011) Intralesional curettage, with phenol and cement as adjuvants, for low-grade intramedullary chondrosarcoma of the long bones. Acta Orthop Belg 77(5):666–669PubMed

40.

De Camargo OP, Baptista AM, Atanásio MJ, Waisberg DR (2010) Chondrosarcoma of bone: lessons from 46 operated cases in a single institution. Clin Orthop Relat Res 468(11):2969–2975CrossRefPubMedPubMedCentral

41.

Souna BS, Belot N, Duval H, Langlais F, Thomazeau H (2010) No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop Relat Res 468(7):1956–1962CrossRefPubMedPubMedCentral

42.

Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F (2010) Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res 468(2):581–589CrossRefPubMed

43.

Aarons C, Potter BK, Adams SC, Pitcher JD Jr, Temple HT (2009) Extended intralesional treatment versus resection of low-grade chondrosarcomas. Clin Orthop Relat Res 467(8):2105–2111CrossRefPubMedPubMedCentral

44.

Ahlmann ER, Menendez LR, Fedenko AN, Learch T (2006) Influence of cryosurgery on treatment outcome of low-grade chondrosarcoma. Clin Orthop Relat Res 451:201–207CrossRefPubMed

45.

Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, Jennings LC (1999) Chondrosarcoma of bone: an assessment of outcome. J Bone Jt Surg Am 81(3):326–338CrossRef

46.

Bauer HC, Brosjö O, Kreicbergs A, Lindholm J (1995) Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities. 80 patients followed for 2–25 years. Acta Orthop Scand 66(3):283–288CrossRefPubMed

47.

Arpaci E, Yetisyigit T, Seker M, Uncu D, Uyeturk U, Oksuzoglu B, Demirci U, Coskun U, Kucukoner M, Isıkdogan A, Inanc M, Alkis N, Ozkan M (2013) Prognostic factors and clinical outcome of patients with Ewing’s sarcoma family of tumors in adults: multicentric study of the Anatolian Society of Medical Oncology. Med Oncol 30(1):469CrossRefPubMed

48.

Feng D, Yang X, Liu T, Xiao J, Wu Z, Huang Q, Ma J, Huang W, Zheng W, Cui Z, Xu H, Teng Y (2013) Osteosarcoma of the spine: surgical treatment and outcomes. World J Surg Oncol 11(1):89CrossRefPubMedPubMedCentral

49.

Han I, Lee YM, Cho HS, Oh JH, Lee SH, Kim HS (2010) Outcome after surgical treatment of pelvic sarcomas. Clin Orthop Surg 2(3):160–166CrossRefPubMedPubMedCentral

50.

Hsieh PC, Xu R, Sciubba DM, McGirt MJ, Nelson C, Witham TF, Wolinksy JP, Gokaslan ZL (2009) Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine (Phila Pa 1976) 34(20):2233–2239CrossRef

51.

Arbeitsgemeinschaft Knochentumoren, Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU (2008) Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Jt Surg Am 90(5):1060–1067CrossRef

52.

Corsat JP, Tomeno B, Forest M, Vinh TS (1989) Benign chondroblastoma. A review of 30 cases. Rev Chir Orthop Reparatrice Appar Mot 75(3):179–187PubMed

53.

Huvos AG, Marcove RC (1973) Chondroblastoma of bone. A critical review. Clin Orthop Relat Res 95:300–312CrossRef

54.

Schwab JH, Wenger D, Unni K, Sim FH (2007) Does local recurrence impact survival in low-grade chondrosarcoma of the long bones? Clin Orthop Relat Res 462:175–180CrossRefPubMed

55.

Boriani S, Saravanja D, Yamada Y, Varga PP, Biagini R, Fisher CG (2009) Challenges of local recurrence and cure in low grade malignant tumors of the spine. Spine (Phila Pa 1976) 34(22 Suppl):S48-57

56.

Brenner W, Conrad EU, Eary JF (2004) FDG PET imaging for grading and prediction of outcome in chondrosarcoma patients. Eur J Nucl Med Mol Imaging 31:189–195CrossRefPubMed

57.

Jesus-Garcia R, Osawa A, Filippi RZ, Viola DC, Korukian M, de Carvalho Campos Neto G, Wagner J (2016) Is PET–CT an accurate method for the differential diagnosis between chondroma and chondrosarcoma? Springerplus 5:236CrossRefPubMedPubMedCentral

58.

De Coninck T, Jans L, Sys G, Huysse W, Verstraeten T, Forsyth R, Poffyn B, Verstraete K (2013) Dynamic contrast-enhanced MR imaging for differentiation between enchondroma and chondrosarcoma. Eur Radiol 23(11):3140–3152CrossRefPubMed

59.

Geirnaerdt MJ, Hogendoorn PC, Bloem JL, Taminiau AH, van der Woude HJ (2000) Cartilaginous tumors: fast contrast-enhanced MR imaging. Radiology 214:539–546CrossRefPubMed

60.

Yoo HJ, Hong SH, Choi JY, Moon KC, Kim HS, Choi JA, Kang HS (2009) Differentiating high-grade from low-grade chondrosarcoma with MR imaging. Eur Radiol 19:3008–3014CrossRefPubMed

Title: Intralesional vs. extralesional procedures for low-grade central chondrosarcoma: a systematic review of the literature
Authors: Carmine Zoccali
Jacopo Baldi
Dario Attala
Barbara Rossi
Vincenzo Anelli
Alessio Annovazzi
Virginia Ferraresi
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-2930-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intralesional vs. extralesional procedures for low-grade central chondrosarcoma: a systematic review of the literature

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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