Long-term results of intralesional curettage and cryosurgery for treatment of low-grade chondrosarcoma.
Citation: Journal of Bone & Joint Surgery - American Volume. 95(15):1358-64, 2013 Aug 7.PMID: 23925739Institution: MedStar Washington Hospital Center | Washington Cancer InstituteDepartment: Orthopedic OncologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Bone Neoplasms/su [Surgery] | *Chondrosarcoma/su [Surgery] | *Cryosurgery | *Curettage | Adult | Aged | Bone Neoplasms/pa [Pathology] | Chondrosarcoma/pa [Pathology] | Cryosurgery/mt [Methods] | Fractures, Spontaneous/ep [Epidemiology] | Humans | Middle Aged | Neoplasm Recurrence, Local/ep [Epidemiology] | Retrospective Studies | Treatment Outcome | Young AdultAbstract: BACKGROUND: Data regarding outcomes following intralesional curettage and cryosurgical treatment of low-grade chondrosarcoma of bone are limited. The aim of this study was to assess the long-term oncologic and functional outcomes of two different cryosurgery techniques.CONCLUSIONS: Intralesional curettage and cryosurgery for low-grade chondrosarcoma is safe and effective in selected patients. The presence of preoperative cortical breakthrough and soft-tissue extension was the strongest predictor of local recurrence following use of this technique.LEVEL OF EVIDENCE: Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.METHODS: Forty-three low-grade chondrosarcoma lesions (in forty-two patients) were treated with intralesional curettage and cryosurgery from June 1983 to October 2006. Eleven lesions were treated with cryoprobes and thirty-two were treated with the modified direct-pour Marcove technique. The mean patient age was 44.9 +/- 11.3 years (range, 21.8 to 66.4 years), and the mean duration of follow-up was 10.2 +/- 4.6 years (range, five to 22.5 years). Indications for treatment included a radiographic appearance consistent with a cartilage tumor with evidence of aggressive behavior. Pearson correlation and multivariate analyses were used to evaluate the relationships between predictive factors (including lesion size, soft-tissue extension, and location, patient age, cortical erosion, and presence of preoperative pain) and outcomes.RESULTS: The mean overall Musculoskeletal Tumor Society (MSTS) score was 26.5 +/- 3.1 (range, 17 to 30). There were four local recurrences, all in patients who had had tumor extension out of the bone with soft-tissue involvement at initial presentation. The mean time to recurrence was 2.4 +/- 2.3 years (range, 0.6 to 5.6 years). No patients developed metastatic disease during the follow-up period. There were no differences between the cryoprobe and Marcove techniques with respect to the MSTS score, fracture, or local recurrence. A significant correlation between tumor recurrence and soft-tissue extension was found (r = 0.79). Kaplan-Meier survivorship, with freedom from recurrence as the end point, was 90.7%.Digital Object Identifier: Date added to catalog: 2013-12-24| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | Available | 23925739 |
BACKGROUND: Data regarding outcomes following intralesional curettage and cryosurgical treatment of low-grade chondrosarcoma of bone are limited. The aim of this study was to assess the long-term oncologic and functional outcomes of two different cryosurgery techniques.
CONCLUSIONS: Intralesional curettage and cryosurgery for low-grade chondrosarcoma is safe and effective in selected patients. The presence of preoperative cortical breakthrough and soft-tissue extension was the strongest predictor of local recurrence following use of this technique.
LEVEL OF EVIDENCE: Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
METHODS: Forty-three low-grade chondrosarcoma lesions (in forty-two patients) were treated with intralesional curettage and cryosurgery from June 1983 to October 2006. Eleven lesions were treated with cryoprobes and thirty-two were treated with the modified direct-pour Marcove technique. The mean patient age was 44.9 +/- 11.3 years (range, 21.8 to 66.4 years), and the mean duration of follow-up was 10.2 +/- 4.6 years (range, five to 22.5 years). Indications for treatment included a radiographic appearance consistent with a cartilage tumor with evidence of aggressive behavior. Pearson correlation and multivariate analyses were used to evaluate the relationships between predictive factors (including lesion size, soft-tissue extension, and location, patient age, cortical erosion, and presence of preoperative pain) and outcomes.
RESULTS: The mean overall Musculoskeletal Tumor Society (MSTS) score was 26.5 +/- 3.1 (range, 17 to 30). There were four local recurrences, all in patients who had had tumor extension out of the bone with soft-tissue involvement at initial presentation. The mean time to recurrence was 2.4 +/- 2.3 years (range, 0.6 to 5.6 years). No patients developed metastatic disease during the follow-up period. There were no differences between the cryoprobe and Marcove techniques with respect to the MSTS score, fracture, or local recurrence. A significant correlation between tumor recurrence and soft-tissue extension was found (r = 0.79). Kaplan-Meier survivorship, with freedom from recurrence as the end point, was 90.7%.
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