Recurrence analysis in 66 cases with grade I and grade II chondrosarcomas in the extremities

Abstract

Objective: We analyzed chondrosarcomas in long bones to assess whether Grade I and II chondrosarcomas should both be grouped as low grade malignant tumors (musculoskeletal Tumor Society Stage I or Stage II), and to explore rational surgical treatment for Grade I and II chondrosarcomas.

Methods: We retrospectively reviewed 66 patients from January 1996 to December 2007 with Grade I and II chondrosarcoma of the extremities without metastases at the Department of Orthopaedics of Shanghai Sixth People's Hospital. Thirty-eight patients had undergone intralesional or marginal resection, and 28 patients had undergone wide marginal or radical excision based on imaging findings. The mean age of the patients was 43 years (range, 5-85) and the minimum follow-up was 31 months (mean, 48; range, 5-141). We analyzed grade diagnosis, therapeutic options, and local recurrence rate of the two grades of chondrosarcoma.

Results: Of all patients, 22 experienced local recurrence, making the local recurrence rate 33.3%. A statistically significant difference in outcome between patients with Grade I and Grade II tumors undergoing intralesional resection was identified. No significant difference according to surgical method was found between the two groups in total.

Conclusion: Grade II chondrosarcomas should be grouped as high stage malignant tumors (Stage II) and grade I chondrosarcomas assigned to the low stage malignant tumor group (Stage I). Our experience suggests the surgical method should be related to radiographic margin status and oncologic classification. Wide resection should be considered for Grade II, while intralesional resection is suitable for Grade I.

Figure 1

Man aged 45 years. (A) Preoperative radiograph demonstrating a calcified lesion (→) in the left distal femur. Pathology showed the lesion to be a Grade I chondrosarcoma. (B) X‐ray image after curettage with bone graft and internal fixation. During follow‐up for 25 months, no evidence of local recurrence was found. () indicates the site after curettage and allogeneic bone graft.) indicates the site after curettage and allogeneic bone graft.

Figure 2

Man aged 31 years. (A) Radiograph demonstrating an osteolytic lesion and cortical disruption with pathological fracture of the medial aspect of the distal femur. Grade II chondrosarcoma was confirmed by pathology preoperatively. (→) indicates the lesion before surgery. (B) MRI showing the lesion involves articular cartilage and surrounding soft tissue. () indicates the lesion before surgery. (C) A 25‐month postoperative X‐ray image showing the appearance after treatment by wide marginal excision and artificial prosthetic replacement. There is no evidence of local recurrence. () indicates the prosthetic replacement.

Figure 3

(A) Grade I chondrosarcoma showing low cellularity with a chondroid matrix and absent mitoses. (B) Mitoses are seen in cells of a grade II chondrosarcoma.

Figure 4

Curves showing the probability of recurrence‐free survival for patients with Grade I and II chondrosarcomas. The difference between patients with Grade I (60%) and Grade II (40%) chondrosarcoma in recurrence‐free survival at almost 140 months was not statistically significant (P= 0.0638).

Figure 5

Curves showing local recurrence‐free survival with intralesional excision. The local recurrence‐free survival at almost 140 months was significantly less for Grade II than for Grade I tumors (P= 0.0261). Recurrence‐free survival with intralesional excision is 60% for Grade I and 15% for Grade II.