Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review.

Musa Mermerkaya,Murat Danisman,Mehmet Ayvaz,Fatih Karaaslan,Senol Bekmez,Ahmet Tokgozoglu,Kemal Kosemehmetoglu,Gokhan Gedikoglu

doi:10.1186/1477-7819-12-336

Abstract

BackgroundVarious treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate.MethodsWe performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012.ResultsThe average age of the patients was 48.7 (range, 18–71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26–85) months after surgery. The treated lesions were located in the proximal humerus (n =10), proximal tibia (n =6), and distal femur (n =5). At the average follow-up time point of 58.4 (range, 26–85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84–100).ConclusionsThe combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.

Highlights

Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature
We retrospectively evaluated 21 patients treated for grade I central CS of a long bone in our hospital from 2007 to 2012 (Table 1)
Wide resection of these indolent, slow-growing, low-grade tumors seems disproportionate in light of the difficulty in distinguishing them from enchondromas [22,23] and the fact that wide resection often results in substantial functional morbidity [24,25]

Summary

Introduction

Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate. Chondrosarcoma (CS) is the second most frequent primary malignant bone tumor after osteosarcoma. The prognosis of central CS is directly correlated with the histological grade of malignancy, which is assessed following the criteria described by Evans et al, which consider the tumor’s cellularity, matrix characteristics, nuclear features, and mitotic rate [2]. Surgery is the primary treatment for cartilage tumors, and the extent of the resection margins depends on the tumor grade and location [7,8]. Radiation therapy and chemotherapy have no substantial role in the treatment of CS [9,10,11]

Objectives

Methods

Results

Discussion

Conclusion