Chondrosarcoma surgery: Difference between revisions

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{{Chondrosarcoma}}
{{Chondrosarcoma}}
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{{CMG}}; {{AE}} {{Rohan}}


==Overview==
==Overview==
[[Surgery]] is the mainstay of treatment for chondrosarcoma. Adjunctive [[chemotherapy]] and [[radiation]] may be required. Recurrence rate depends on the grade of chondrosarcoma.


==Surgery==
==Surgery==
Because chondrosarcoma affects different parts of the body, the type of treatment depends on the size, location, and grade of the tumor. Musculoskeletal Tumor Specialists or Orthopedic Oncologists are the most qualified to treat chondrosarcoma, unless it is located in the skull, spine, or chest cavity, in which case, a neurosurgeon or Thoracic surgeon experienced with sarcomas would be needed.
*Surgery is the mainstay treatment for chondrosarcoma.<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref><ref>{{cite book | last = Czerniak | first = Bogdan | title = Dorfman and Czerniak's bone tumors | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2016 | isbn = 9780323023962 }}</ref><ref name="pmid30559960">{{cite journal| author=Lex JR, Evans S, Stevenson JD, Parry M, Jeys LM, Grimer RJ| title=Dedifferentiated chondrosarcoma of the pelvis: clinical outcomes and current treatment. | journal=Clin Sarcoma Res | year= 2018 | volume= 8 | issue=  | pages= 23 | pmid=30559960 | doi=10.1186/s13569-018-0110-1 | pmc=6293503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30559960  }} </ref><ref name="pmid8608505">{{cite journal| author=Ozaki T, Lindner N, Hillmann A, Rödl R, Blasius S, Winkelmann W| title=Influence of intralesional surgery on treatment outcome of chondrosarcoma. | journal=Cancer | year= 1996 | volume= 77 | issue= 7 | pages= 1292-7 | pmid=8608505 | doi=10.1002/(SICI)1097-0142(19960401)77:7<1292::AID-CNCR10>3.0.CO;2-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8608505  }} </ref><ref name="pmid11029557">{{cite journal| author=Marco RA, Gitelis S, Brebach GT, Healey JH| title=Cartilage tumors: evaluation and treatment. | journal=J Am Acad Orthop Surg | year= 2000 | volume= 8 | issue= 5 | pages= 292-304 | pmid=11029557 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11029557  }} </ref>
 
===Intra-Lesional Curettage===
'''Indications'''
*Grade 1 chondrosarcoma involving the [[extremities]].  
 
===Wide Surgical Excision===       
 
'''Indications'''
*Grade 2 or 3 chondrosarcoma anywhere in the body.
*Grade 1 chondrosarcoma in [[pelvis]].
 
===Wide Surgical Excision Combined with Multi-Agent Chemotherapy=== 
 
'''Indications'''
*Mesenchymal chondrosarcoma.
 
===Limb-salvage through Pelvic Resection with or without Reconstruction===


*Surgery is the main form of treatment for chondrosarcoma.
'''Indications'''
*Treatment depends on the location of the disease and the aggressiveness of the tumors [http://www.cancerbacup.org.uk/Cancertype/Bone/Typesofbonecancer/Chondrosarcoma#3340]. Often, a limb-sparing operation can be performed [http://www.seattlecca.org/patientsandfamilies/adultCare/clinicalProgs/sarcoma/BoneCancerTreatmentOptions/LimbSparingSurgery.htm], however in some cases amputation is unavoidable.
*Dedifferentiated chondrosarcoma involving the [[pelvis]].<ref name="pmid15523011">{{cite journal| author=Dickey ID, Rose PS, Fuchs B, Wold LE, Okuno SH, Sim FH et al.| title=Dedifferentiated chondrosarcoma: the role of chemotherapy with updated outcomes. | journal=J Bone Joint Surg Am | year= 2004 | volume= 86-A | issue= 11 | pages= 2412-8 | pmid=15523011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15523011  }} </ref>
*Amputation of the [[arm]], [[leg]], [[jaw]], or half of the [[pelvis]] (called a [[hemipelvectomy]]) may be necessary in some cases.
 
*Even more rare are chondrosarcoma located in the skull base, spine, rib cage, or larynx. Complete surgical ablation is the treatment, but sometimes this is difficult. [[Proton therapy]] Radiation can be useful in these rare locations to make surgery more effective. Follow up scans are extremely important for chondrosarcoma to make sure there has been no recurrence or metastasis, which usually occurs in the lungs. Unlike other cancers, chondrosarcoma can return many years later.
===Limb-sacrifice with Hindquarter Amputation===
 
'''Indications'''
*Dedifferentiated chondrosarcoma involving the [[pelvis]]<ref name="pmid15523011">{{cite journal| author=Dickey ID, Rose PS, Fuchs B, Wold LE, Okuno SH, Sim FH et al.| title=Dedifferentiated chondrosarcoma: the role of chemotherapy with updated outcomes. | journal=J Bone Joint Surg Am | year= 2004 | volume= 86-A | issue= 11 | pages= 2412-8 | pmid=15523011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15523011  }} </ref>
 
===Recurrence Rate===
 
'''Grade 1 chondrosarcoma'''
*It is rare after wide [[resection]] with negative margins.
*5-15% is the recurrence rate after [[curettage]] with [[adjuvant treatment]].
 
'''Grade 2 chondrosarcoma'''
*The recurrence rate varies depending on [[resection]] margins.
 
'''Grade 3 chondrosarcoma'''
*The local recurrence rate is 25% and >30% chances of [[metastasis]].
{|
|[[File:Chondrosarcoma clinical image.gif|500px|thumb|Chondrosarcoma of glenoid and scapula. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]
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==References==
==References==
{{reflist|2}}
{{Reflist|2}}


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Latest revision as of 15:04, 13 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Surgery is the mainstay of treatment for chondrosarcoma. Adjunctive chemotherapy and radiation may be required. Recurrence rate depends on the grade of chondrosarcoma.

Surgery

Intra-Lesional Curettage

Indications

Wide Surgical Excision

Indications

  • Grade 2 or 3 chondrosarcoma anywhere in the body.
  • Grade 1 chondrosarcoma in pelvis.

Wide Surgical Excision Combined with Multi-Agent Chemotherapy

Indications

  • Mesenchymal chondrosarcoma.

Limb-salvage through Pelvic Resection with or without Reconstruction

Indications

  • Dedifferentiated chondrosarcoma involving the pelvis.[6]

Limb-sacrifice with Hindquarter Amputation

Indications

  • Dedifferentiated chondrosarcoma involving the pelvis[6]

Recurrence Rate

Grade 1 chondrosarcoma

Grade 2 chondrosarcoma

  • The recurrence rate varies depending on resection margins.

Grade 3 chondrosarcoma

  • The local recurrence rate is 25% and >30% chances of metastasis.
Chondrosarcoma of glenoid and scapula. Source: Case courtesy by: Dr. Rohan A. Bhimani


References

  1. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  2. ↑ Czerniak, Bogdan (2016). Dorfman and Czerniak's bone tumors. Philadelphia, PA: Elsevier/Saunders. ISBN 9780323023962.
  3. ↑ Lex JR, Evans S, Stevenson JD, Parry M, Jeys LM, Grimer RJ (2018). "Dedifferentiated chondrosarcoma of the pelvis: clinical outcomes and current treatment". Clin Sarcoma Res. 8: 23. doi:10.1186/s13569-018-0110-1. PMC 6293503. PMID 30559960.
  4. ↑ Ozaki T, Lindner N, Hillmann A, Rödl R, Blasius S, Winkelmann W (1996). "Influence of intralesional surgery on treatment outcome of chondrosarcoma". Cancer. 77 (7): 1292–7. doi:10.1002/(SICI)1097-0142(19960401)77:7<1292::AID-CNCR10>3.0.CO;2-X. PMID 8608505.
  5. ↑ Marco RA, Gitelis S, Brebach GT, Healey JH (2000). "Cartilage tumors: evaluation and treatment". J Am Acad Orthop Surg. 8 (5): 292–304. PMID 11029557.
  6. ↑ 6.0 6.1 Dickey ID, Rose PS, Fuchs B, Wold LE, Okuno SH, Sim FH; et al. (2004). "Dedifferentiated chondrosarcoma: the role of chemotherapy with updated outcomes". J Bone Joint Surg Am. 86-A (11): 2412–8. PMID 15523011.


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