Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function

Abstract

Background: Chondrosarcomas of bone traditionally have been treated by wide or radical excision, procedures that may result in considerable lifelong disability. Grade 1 chondrosarcomas have little or no metastatic potential and are often difficult to distinguish from painful benign enchondromas. Curettage with adjuvant cryosurgery has been proposed as an alternative therapy for Grade 1 chondrosarcomas given the generally better function after the procedure. However, because it is an intralesional procedure, curettage and cryosurgery may be associated with higher rates of recurrence.

Questions/purposes: We asked whether Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery are associated with low recurrence rates and high functional scores.

Patients and methods: We retrospectively reviewed the records of 46 patients with Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery. Forty-one patients had tumors of the long bones. Patients were followed a minimum of 18 months (average, 47.2. months; range, 18-134 months) for evidence of recurrence and for assessment of Musculoskeletal Tumor Society (MSTS) functional score.

Results: Two of the 46 patients had recurrences in the original tumor site (4.3% recurrence rate), which subsequently were removed by wide excision, and both patients were confirmed to be disease-free 36 and 30 months, respectively, after the second surgery. The mean MSTS score was 27.2 of 30 points (median, 29 points).

Conclusions: Our observations show curettage with cryosurgery is associated with low recurrence of Grade 1 chondrosarcoma and high functional scores. Curettage with cryosurgery is a reasonable alternative to wide or radical excision as the treatment for Grade 1 chondrosarcomas, and allows for more radical surgery in the event of local recurrence.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–B

Distribution of patient demographics is shown with respect to (A) patient age and (B) followup time.

Fig. 2A–D

The radiographic images show a Grade 1 chondrosarcoma of the proximal humerus (A) before and (B) after removal by curettage and cryosurgery with postoperative good outcome, (C) the local recurrence in the right proximal femur, and (D) the residual tumor (second recurrent case) in the right proximal humerus.

Fig. 3

Distribution of Musculoskeletal Tumor Society (MSTS) functional scores is shown with respect to categories of ≥ 23 (excellent result), 15–22 (good result), 8–14 (fair result), and < 8 (poor result).