Abstract
PurposeThere are no clear guidelines for staging of conventional chondrosarcoma. We conducted an online survey to determine the current practices for skeletal staging for conventional chondrosarcoma among practicing oncologists and to assess any discrepancy in practices and with the published literature.MethodologyA simple ten-question online survey (e-mails and WhatsApp) was conducted among practicing oncologists over a period of 3 weeks using online portal (surveymonkey.com). It was followed by analysis based on each question to find current practices.Results139 members participated in the survey (84% surgeons, 9% radiologists, 3% medical and 3% radiation oncologists and 1% nuclear medicine). 65% have been treating chondrosarcoma for more than 5 years. 88% opined that biopsy is mandatory even if the radiology is suggestive of a chondrosarcoma. 66% said that solitary skeletal metastasis is seen in less than 2% of the cases but 84% of participants were in favour of performing an investigation (bone scan/PET scan) for skeletal survey. While 43% opined skeletal metastasis is more common in recurrent chondrosarcoma, 26% said that performing a bone scan was likely to impact management, 28% said it will not impact management and 46% were unsure. Of the group who thought that a bone scan would impact management or were unsure, the majority (56%) opined that this was relevant only in grade 2 and grade 3 chondrosarcoma.ConclusionThere was lack of consensus regarding staging for chondrosarcoma. Only 26% of respondents were convinced that performing a bone scan was likely to impact management of chondrosarcoma. There is a need to analyze large data sets (retrospective/prospective) to arrive at an evidence-based staging algorithm for chondrosarcoma.
Highlights
Chondrosarcomas are the second most common solid malignant tumors of bone, commonly seen after the age of 40 years [1, 2]
12% of participants said that they would not perform a biopsy before the final surgical intervention (Fig. 2b). 65% of the participants were of the opinion that pulmonary metastasis was the most common site for metastasis in chondrosarcoma whereas 31% were in favor of combined pulmonary and skeletal sites (Fig. 3b)
In spite of recognizing the fact that skeletal metastasis was rare in chondrosarcoma, 84% of participants still perform an investigation for skeletal survey (Fig. 3a)
Summary
Chondrosarcomas are the second most common solid malignant tumors of bone, commonly seen after the age of 40 years [1, 2]. They are a heterogeneous group which share in common the production of chondroid matrix [3]. Staging plays an integral part in management of bone sarcomas as the intent of treatment depends on results of staging. Current NCCN or ESMO guidelines have suggested using bone scan with a non-contrast computerized tomography of the thorax (NCCT) or a fluorodeoxyglucose positron emission tomography (FDG-PET) scan for staging in chondrosarcoma similar to other sarcomas [4, 5]. There is limited literature available on staging in chondrosarcoma with a few reports mentioning the incidence of bone metastasis to be less than 1% [6]
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