High-risk extracranial chondrosarcoma: long-term results of surgery and radiation therapy

Cancer. 2011 Jun 1;117(11):2513-9. doi: 10.1002/cncr.25806. Epub 2011 Jan 18.

Abstract

Background: A study was undertaken to evaluate results of surgery and radiotherapy (RT) for high-risk extracranial chondrosarcomas.

Methods: Between 1986 and 2006, 60 patients underwent surgery and RT for extracranial high-risk chondrosarcoma. Preoperative RT (median, 50 gray [Gy]) and postoperative RT (median, 60 Gy) were used in 40% and 60% patients, respectively. Sites included pelvis/lower extremity (48%), chest wall (22%), spine/paraspinal (17%), and head and neck (13%). Overall, median tumor size was 7 cm (range, 1-22 cm), and tumor grade was I, II, and III in 22%, 64%, and 14% of cases, respectively.

Results: Pathologically clear surgical margins (R0) were present in 50%, microscopic positive margins (R1) in 28%, and gross positive margins (R2) in 13%, half of whom had clinically detectable residual disease; surgical margin was unknown in 8%. Median follow-up was 75 months (range, 5-230 months). The crude local control rate was 90%. Patients with R0, R1, and R2 resections had local control of 100%, 94%, and 42%, respectively. Of the 8 cases that had R2 resection, 3 experienced uncontrolled progression, but 5 patients had stable disease with long-term follow-up. The 10-year overall survival, progression-free survival, and cause-specific survival were 86%, 80.5%, and 89.4%, respectively. Younger age and grade III tumors were associated with worse progression-free survival (P = .03 and .0003, respectively).

Conclusions: Although surgery with complete resection is paramount in management of chondrosarcoma, RT is a useful adjuvant treatment and appears to offer excellent and durable local control where wide surgical resection is difficult to accomplish.

Keywords: chondrosarcoma; extracranial; radiation therapy; surgery.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnosis
  • Bone Neoplasms / mortality
  • Bone Neoplasms / radiotherapy*
  • Bone Neoplasms / surgery*
  • Chondrosarcoma / diagnosis
  • Chondrosarcoma / mortality
  • Chondrosarcoma / radiotherapy*
  • Chondrosarcoma / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Recurrence
  • Salvage Therapy
  • Treatment Outcome
  • Tumor Burden
  • Young Adult