Existence Of Distant Metastases Research Articles

Orbital Exenteration in Recurrence Cancer: 5 Years Experience.

The purpose of this study was to assess the overall survival (OS) and disease-free survival (DFS) of patients who underwent orbital exenteration for periorbital, conjunctival, and primary intraorbital carcinomas. Additionally, we assessed the outcomes of anterior retrograde temporalis muscle flap restoration. For all patients who had orbital exenteration in the previous five years, a non-comparative retrospective assessment of their medical records, histology, and radiographic imaging was carried out. We investigated the relationships between the various qualitative factors using Cramer's V Kaplan-Meier (KM) analysis. For each of the patient's categorical factors that were of relevance, estimates of the survival distribution were displayed, and log-rank tests were used to determine whether the survival distributions were equal. This study looks at 19 participants. The sample is made up of 13 men (68%) and 6 women (32%). The degree of relationship (Cramer's V index) between lymph node metastases (N) and the existence of distant metastases (M) is high, at 64%, and is statistically significant because the p-value is 0.0034 < 0.005. Lymph node metastases had a statistically significant impact on overall survival (p = 0.04 < 0.05). Thirteen of the nineteen patients tested had no palsy (68%). There was no one presenting a CSF leak. Our findings show how crucial it is to identify any lymph node involvement that orbital neoplasms may have. In patients who have received many treatments, sentinel lymph node biopsy (SLNB) may be used to determine the stage and spread of the cancer. To determine whether additional tumor characteristics may be explored, more expertise in the SLNB field for patients with orbital cancer who have received many treatments may be helpful. To prevent additional scarring and to be comparable to previous techniques for facial nerve lesions, the anterior retrograde approach and the transorbital procedure for temporal muscle flap in-setting are both effective methods.

EGFR, HER2, and HER3 protein expression in paired primary tumor and lymph node metastasis of colorectal cancer

Due to the difficulty in sampling of metastatic tumors, patient selection is commonly based on results of primary tumor samples when metastatic samples are not available. However, due to tumor heterogeneity, metastatic tumors may be different from primary tumors in their phenotypes. The aim of this study was to investigate the expression of EGFR, HER2, and HER3 between primary and lymph node metastatic lesions of colorectal cancer. Paired primary tumors and lymph node metastases from 79 patients with colorectal cancer were retrospectively collected and analyzed for EGFR, HER2, and HER3 expression. High EGFR, HER2, and HER3 expression (2+ and 3+) was found in 64.2%, 66.0%, and 85.0% of primary tumors, and 56.8%, 46.0%, and 76.0% of lymph node metastases, respectively. Correlation rates between primary and metastatic lesions were 67.1%, 63.3%, and 74.7% for EGFR, HER2, and HER3, respectively. Stage IV tumors (with distant metastasis) had higher correlation rates of HER2 expression compared to stage III tumors (without distant metastasis) (P = 0.050). Moderate correlation rates in EGFR, HER2, and HER3 expression were observed between primary and metastatic lesions of colorectal cancer. Tumor stage or existence of distant metastasis could serve as potential predictive markers for the correlation of HER2 expression between primary tumors and lymph node metastases of colorectal cancer.

TNM-O: ontology support for staging of malignant tumours.

BackgroundObjectives of this work are to (1) present an ontological framework for the TNM classification system, (2) exemplify this framework by an ontology for colon and rectum tumours, and (3) evaluate this ontology by assigning TNM classes to real world pathology data.MethodsThe TNM ontology uses the Foundational Model of Anatomy for anatomical entities and BioTopLite 2 as a domain top-level ontology. General rules for the TNM classification system and the specific TNM classification for colorectal tumours were axiomatised in description logic. Case-based information was collected from tumour documentation practice in the Comprehensive Cancer Centre of a large university hospital. Based on the ontology, a module was developed that classifies pathology data.ResultsTNM was represented as an information artefact, which consists of single representational units. Corresponding to every representational unit, tumours and tumour aggregates were defined. Tumour aggregates consist of the primary tumour and, if existing, of infiltrated regional lymph nodes and distant metastases. TNM codes depend on the location and certain qualities of the primary tumour (T), the infiltrated regional lymph nodes (N) and the existence of distant metastases (M). Tumour data from clinical and pathological documentation were successfully classified with the ontology.ConclusionA first version of the TNM Ontology represents the TNM system for the description of the anatomical extent of malignant tumours. The present work demonstrates its representational power and completeness as well as its applicability for classification of instance data.

Brain Metastasis in Pancreatic Cancer

Pancreatic cancer is a fatal disease with a 5-year survival rate below 5%. Most patients are diagnosed at an advanced tumor stage and existence of distant metastases. However, involvement of the central nervous system is rare in pancreatic cancer. We retrospectively analyzed all cases of brain metastases in pancreatic cancer reported to date focusing on patient characteristics, clinical appearance, therapy and survival. Including our own, 12 cases of brain metastases originating from pancreatic cancer were identified. In three patients brain metastases were the first manifestation of pancreatic cancer. All other patients developed brain metastases during their clinical course. In most cases, the disease progressed rapidly and the patients died within weeks or months. However, two patients showed long-term survival. Of note, both patients received resection of the pancreatic cancer as well as curative resection of the metachronous brain metastases. Brain metastases in pancreatic cancer are a rare condition and usually predict a very poor prognosis. However, there is evidence that resection of brain metastases of pancreatic cancer can be immensely beneficial to patient’s survival, even with the chance for cure. Therefore, a surgical approach in metastatic pancreatic cancer should be considered in selective cases.

Combining case-based reasoning with Bee Colony Optimization for dose planning in well differentiated thyroid cancer treatment

Thyroid cancers are the most common endocrine carcinomas. Case-based reasoning (CBR) is used in this paper to describe a physician’s expertise, intuition and experience when treating patients with well differentiated thyroid cancer. Various clinical parameters (the patient’s diagnosis, the patient’s age, the tumor size, the existence of metastases in the lymph nodes and the existence of distant metastases) influence a physician’s decision-making in dose planning. The weights (importance) of these parameters are determined here with the Bee Colony Optimization (BCO) meta-heuristic. The proposed CBR–BCO model suggests the I-131 iodine dose in radioactive iodine therapy. This approach is tested on real data from patients treated in the Department of Nuclear Medicine, Clinical Center Kragujevac, Serbia. By comparing the results that are obtained through the developed CBR–BCO model with those resulting from the physician’s decision, it has been found that the developed model is highly reflective of reality.

Abdominoperineal Resection for Squamous Cell Anal Carcinoma: Survival and Risk Factors for Recurrence

Despite the results of combined chemoradiation therapy for anal canal squamous cell carcinoma (SCC), up to 30 % of patients will undergo abdominoperineal resection (APR). The aim of this study was to evaluate oncologic outcomes, survival, and recurrence, following APR for anal canal SCC performed in a single center over a 13-year period. All patients who underwent APR for anal canal SCC between 1996 and 2009 were retrospectively included. Demographic data, details on treatments, pathological report, and follow-up were noted. Survival curves were plotted using the Kaplan-Meier method and potential prognostic factors were evaluated using Cox proportional hazards models. A total of 105 patients (77 women) were included. Indications for APR included tumor persistence (n = 42; 40 %), recurrence (n = 55; 52.4 %), or a contraindication to radiotherapy (n = 8; 7.6 %). Median follow-up was 33.3 months (range, 1.5-174.3 months). Overall survival and disease-free survival were, respectively, 61 and 48 % at 5 years. In multivariate analysis, tumor stage (T3 or T4), positive margin on pathologic examination and existence of distant metastases at the time of the surgery were associated with a poor prognosis. The indication for APR (persistent vs recurrent disease), gender, concurrent HIV infection, or performance of a VRAM flap did not influence OS or DFS. Overall recurrence rate was 42.6 % (n = 43 of 101). The type of recurrence did not exert a significant effect on survival (p = .4571). This study describes the largest single series of APR for anal carcinoma. Major prognostic factors for survival and recurrence were T status and involved margin. The 5-year overall survival was 60 %.

Zur Prognose chirurgisch therapierter primärer Parotiskarzinome – eine Untersuchung an 231 Fällen

We present our results on the prognosis of parotid gland cancer with the help of a group of patients who were treated in a standardised manner and received a long term follow-up.We retrospectively analysed the clinicopathological data of 231 patients with a surgically treated primary parotid gland cancer and calculated survival parameters. The mean follow-up time was 52 months.The 5- and 10-year overall survival rate was 74.2% and 66.9%. 70 patients got a locoregional recurrence, 18.6% of those even after more than 5 years. Initial facial nerve palsy was a significant negative prognostic indicator for the disease-free survival. The most frequent histological subtypes could be divided into 3 prognostic groups with significant differences in the survival. The pathological tumour stage was a prognostic indicator for a worse overall and disease-free survival. The pT-stage, the pN-stage and the existence of distant metastases were independent prognostic factors.The group of patients is mainly characterised by the large size, the standardised therapy and the long follow-up time. We could show that the facial nerve palsy is a severe negative prognostic factor. For practical purpose, the classification into 3 histological subgroups seemed to be of great help. This should be considered in patient follow-up. Due to the amount of late recurrences, we propose a follow-up time longer than 5 years. We propose standardized surgery including total parotidectomy in combination with neck dissection.

Matrix metalloproteinase-13 is regulated by toll-like receptor-9 in colorectal cancer cells and mediates cellular migration

Matrix metalloproteinases (MMPs) are associated with cancer cell invasion and metastasis, and are currently the most prominent proteases associated with tumorigenesis. In particular, abundant expression of MMP-13 in colorectal cancer (CRC) is correlated with poor survival and the existence of distant metastasis. As suggested by recent in vitro studies, MMP-13 expression is regulated in a toll-like receptor (TLR)-9-dependent manner. In this study, we quantified the expression of MMP-13, TLR-9 and second messengers of the TLR signal transduction in CRC cells compared to colonic fibroblasts by RT-PCR. Furthermore, the effects of a selective TLR-9 stimulation on the expression of MMP-13 in CRC cells and colonic fibroblasts were analyzed. MMP-13 and TLR-9 as well as associated second messengers were simultaneously up-regulated in LS174 and SW620 cells compared to fibroblasts. Selective TLR-9 agonism with CpG oligonucleotides led to a significant increase in MMP-13 gene expression after 12 h of incubation in LS174 cells and after 12 and 24 h in SW620 cells, but not when using GpC oligonucleotides as a control substance. By contrast, MMP-13 gene expression remained unchanged in colonic fibroblasts following treatment with CpG or GpC oligonucleotides. The effects of selective MMP-13 inhibition on cellular migration were analyzed in Boyden chamber experiments. In the presence of 10 and 20 μM of the specific MMP-13 inhibitor, CL-82198, migration of the LS174 cells was significantly reduced by 55 and 52%, respectively, compared to untreated cells. In conclusion, the results of this study provide evidence of the TLR-9-dependent regulation of MMP-13 in CRC cells, but not in colonic fibroblasts. Since the specific inhibition of MMP-13 significantly reduces the migration of LS174 cells, selective MMP-13 inhibition may be a promising therapeutic strategy in CRC.

Serum high mobility group box-1 (HMGB1) is closely associated with the clinical and pathologic features of gastric cancer

BackgroundHigh mobility group box-1 (HMGB1) is a newly recognized factor regulating cancer cell tumorigenesis, expansion and invasion. We investigated the correlation between the serum HMGB1 levels and the clinical and pathologic features of gastric cancer and evaluated the validity of HMGB1 as a potential biomarker for the early diagnosis of gastric cancer.MethodsA total of 227 subjects were classified into 5 disease groups according to the 'gastritis-dysplasia-carcinoma' sequence of gastric carcinogenesis and their serum levels of HMGB1 were analyzed by an enzyme-linked immunosorbent assay (ELISA) method. Clinical parameters, International Union Against Cancer (UICC) TNM stage, cancer size, differentiation or lymphatic invasion, vascular or perineural invasion and prognosis were used as analysis variables.ResultsThe serum HMGB1 levels were significantly different among disease groups (ANOVA, p < 0.05) and HMGB1 levels tended to increase according to the progression of gastric carcinogenesis. Serum HMGB1 levels were significantly associated with depth of invasion, lymph node metastasis, tumor size, and poor prognosis (p < 0.05). However, HMGB1 levels were not associated with patient gender or age, differentiation of tumor cells, or lymphatic, vascular and perineural invasion, or the existence of distant metastasis in advanced cancer (p > 0.05). The sensitivity and specificity of serum HMGB1 was 71% and 67% (cut-off value of 5 ng/ml) for the diagnosis of early gastric cancer, and 70% and 64% (cut-off value of 4 ng/ml) for the diagnosis of high-risk lesions, respectively. These values were greater than those for carcinoembryonic antigen (CEA) (30–40% of sensitivity).ConclusionHMGB1 appears to be a useful serological biomarker for early diagnosis as well as evaluating the tumorigenesis, stage, and prognosis of gastric cancer.

Iterative local Gaussian clustering for expressed genes identification linked to malignancy of human colorectal carcinoma.

Gene expression profiling plays an important role in the identification of biological and clinical properties of human solid tumors such as colorectal carcinoma. Profiling is required to reveal underlying molecular features for diagnostic and therapeutic purposes. A non-parametric density-estimation-based approach called iterative local Gaussian clustering (ILGC), was used to identify clusters of expressed genes. We used experimental data from a previous study by Muro and others consisting of 1,536 genes in 100 colorectal cancer and 11 normal tissues. In this dataset, the ILGC finds three clusters, two large and one small gene clusters, similar to their results which used Gaussian mixture clustering. The correlation of each cluster of genes and clinical properties of malignancy of human colorectal cancer was analysed for the existence of tumor or normal, the existence of distant metastasis and the existence of lymph node metastasis.

Surfactant protein gene expressions for detection of lung carcinoma cells in peripheral blood

Inflow of tumor cells to circulation is an essential step for metastasis of primary tumors. To know its state may contribute to therapeutic strategy. However, methodology to detect lung carcinoma cells floating in peripheral blood has not been established. Pulmonary surfactant protein (SP)-A, SP-C and Clara cells-10 kd protein (CC10) are specific to the lung and often expressed in primary lung carcinomas. We evaluated the worth of these gene expressions for the detection of carcinoma cells in peripheral blood. The expressions in 5 ml of venous blood were tested by RT-PCR. Ninety-nine patients with non-small cell lung carcinoma (NSCLC) and 17 with small cell lung carcinoma (SCLC) were compared to 13 with secondary lung tumor, 48 with non-malignant respiratory diseases and 19 healthy volunteers. The mRNA expressions of SP-A and SP-C were completely specific to NSCLC when compared to SCLC and secondary lung tumors. All of the healthy volunteers and patients with non-malignant respiratory diseases showed negative for these mRNA expressions, except for one sample. The positive rate of SP-A, SP-C and CC10 mRNA in patients with NSCLC was 33.3%, 14.1%, 3.3%, respectively. The rates of SP-A and SP-C mRNA were higher than that (11.1%) in CEA mRNA. The increased positive rate of mRNA of SP-A and SP-C was significantly dependent on the clinical stage and the existence of distant metastasis. These results demonstrate that the detection of mRNA of SP-A and SP-C would give clinicians valuable information suggesting the presence of blood-floating carcinoma cells as a step toward metastasis.

Impacto clínico-biológico de la positividad de la pS2 en carcinomas ductales infiltrantes de mama receptor de estrógenos negativos

The pS2 protein is regulated by estrogens, but it can also be expressed in hormone independent breast carcincomas. We have carried out the present study in order to analyze the clinical-biological impact of pS2 positivity (>2 ng/mg prt.) in negative estrogen receptors (< 10 fmol/mg prt.) infiltrating ductal breast carcinomas (IDC). 97 negative ER-IDC have been included in our study. We established the doses of the cytosol levels of pS2, progesterone receptors (PR), cathepsin D, tissue -type plasminogen activator (t-PA) and hyaluronic acid (HA), as well as the levels of HA, epidermal growth factor receptor (EGFR), CD44v5 and CD44v6 in cell surface membranes. We also considered the menopausal status, histological grade, ploidy, cellular synthesis phase, tumor size, axillary lymph node involvement and the existence of distant metastasis. The same results were obtained when the progesterone receptor status was also considered. ER-/pS2+ IDC presented higher (p <0,05) PR, t-PA and HA cytosol level, as well as lower EGFR concentrations, S-phase > 7% and S-phase >14% and lower N+>10 percentages and aneuploidy. They were also more frequently CD44v6+. The same results were observed when the positivity of the progesterone receptors was considered. The above results lead us to consider that the positivity for pS2 in ER- IDC is associated with hormone-dependent parameters, good differentiation and lower cellular proliferation, which can explain a better clinical outcome.

Modulation of interleukin-18 expression in human colon carcinoma: consequences for tumor immune surveillance.

The production in colon cancer of interferon-gamma (IFN-gamma), a type-1 T-helper (TH1) cytokine, is considered as a marker of good prognosis. We asked whether interleukin-18 (IL-18), which strongly induces IFN-gamma and regulates Fas ligand (Fas-L)-dependent cytotoxicity, may play a role in colon homeostasis, and if its expression was modulated in colon adenocarcinomas. We analyzed 14 specimens of colon adenocarcinomas, 6 of normal colon mucosa of the series, and 6 colon-tumor cell lines. The expression of IL-18, of ICE protease, involved in the processing of this cytokine, and of the downstream effectors of IL-18, IFN-gamma and Fas-L was analyzed by RT-PCR. We further performed IL-18 immunostaining of normal and tumor specimens. The results were correlated with tumor dissemination and clinical outcome. We report the synthesis of IL-18 in human normal colon, mainly by epithelial cells of the mucosa. Out of the 6 tumor cell lines, 4 expressed IL-18 transcripts, but neither ICE mRNA nor secreted forms of IL-18 were detected. We observed decreased or abolished synthesis of IL-18 in colon adenocarcinomas, as compared with normal mucosa. Thus, half of the colon-cancer tissues (7/14 cases) expressed neither IFN-gamma nor Fas-L. This feature was correlated with the existence of distant metastases (Fischer's exact test, p = 0.02) and an unfavorable outcome. These findings suggest that production of IL-18 in human colon may play a role in homeostasis and in tumor immune surveillance, by enhancing IFN-gamma production and Fas-L-dependent cytotoxicity of immune cells.

Urinary levels of monocyte chemo-attractant protein-1 correlate with tumour stage and grade in patients with bladder cancer.

To determine if the chemokine monocyte chemo-attractant protein-1 (MCP-1) is produced locally in patients with bladder cancer and to analyse a possible correlation between tumour stage, grade and metastatic spread, and the urinary and systemic levels of MCP-1. PATIENTS SUBJECTS AND METHODS: Urine and serum samples were obtained from 60 patients with bladder cancer and 20 control subjects. Tumour stage, grade, metastasis and nodal status were assessed. MCP-1 levels in serum and urine were determined using a sandwich enzyme-linked immunosorbent assay. Two transitional cell cancer cell lines (grade I and grade III) were analysed for MCP-1 production under normal and nutritive-stress cell culture. The correlation of urinary MCP-1 levels with tumour stage, grade and distant metastasis was highly significant. Patients with stage T2-T4 bladder cancer had three to fourfold higher mean MCP-1 concentrations (pg/mL) in their urine than those with T1 stage tumours or than the controls (controls 260; T1 359; T2 967; T3 917; T4 1829; P < 0.005). A tumour grade of > GI and the existence of distant metastasis (M1) also correlated significantly with higher urinary MCP-1 levels (GI 373; GII 661; GIII 1111; M0 644; M1 1379; P < 0.05). No differences in circulating serum MCP-1 level were detected between controls and patients. The low-grade (GI) RT4 bladder cancer cell line produced only traces of MCP-1, which did not change under nutritional stress; in contrast, the highly malignant T24 bladder cancer cell line (GIII) spontaneously secreted large amounts of MCP-1 (approximately 7000 pg/mL) which increased under nutritive stress to 13,000 pg/mL. MCP-1, as a potent monocyte chemo-attractant to tumour sites, is probably produced by bladder cancer cells; MCP-1 levels in the vicinity of the tumour (i.e. urine) correlate significantly with TNM stage and grade. As has already been shown in other neoplasms, the resulting monocyte/macrophage infiltrate possibly facilitates tumour neovascularization and tissue invasion. Therefore, MCP-1 levels in the urine of patients with bladder cancer may be a prognostic marker for the natural course of the disease, and modulation of this chemokine might be a future therapeutic approach for adjuvant treatment of bladder cancer.

Das primär ossär metastasierte Mammakarzinom

The purpose of the present study was to analyse prognostic variables, predict the site of metastatic recurrence and to compare the clinical course and survival of patients with primary metastases. Material and methods: The records of 112 patients with primary metastatic breast cancer (disease-free interval less than 3 months or distant metastases at the time of diagnosis) treated at the Department of Gynaecology and Obstetrics of the University of Heidelberg between 1970 and 1990 were reviewed retrospectively. 648 patients with secondary distant metastases (disease-free interval of more than 3 months) served as controls. Results: The first metastatic site was the skeleton in 55 patients, visceral organs in 32 women, while 25 patients had concomitant osseous and visceral metastases. 58% of patients (n=32) with primary metastases confined to the skeleton had large tumours (T3-4) and 87% of these women were node-positive. Bone metastases were predominantly found in the axial skeleton (thoracic spine 69%, pelvis 55%, lumbar spine 51%). The symptoms and complications associated with bone metastases were: pain (67%), fractures (40%), hypercalcaemia (24%), myelopathy (13%) and spinal cord compression (7%). The median overall survival (OAS) in all 112 patients with primary metastatic breast cancer was 18 months. Kaplan-Meier analysis revealed that patients with bone metastases had a significantly longer overall survival (median 31 months) than those with visceral metastases (median 10 months). Conclusion: The existence of distant metastases at the time of diagnosis is usually associated with aggressive malignancy or an advanced primary tumour. 11.4% of patients with distant metastases were node-negative, which shows that the axillary lymph node status is not an ideal prognostic factor for assessing haematogenic metastases. Patients with primary metastatic breast cancer confined to the skeleton have a better prognosis than patients with visceral metastases. The metastatic affinity of highly differentiated tumours to the skeleton possibly contributes to the better prognosis of patients with skeletal metastases.

Fatal differentiated thyroid cancer

Thirty-five patients who died of differentiated thyroid cancer were analyzed for factors affecting survival. The neck was the most common initial site of recurrence (62.0%). The lung was the most common metastatic site (56.7%). Major sites associated with death were locoregional recurrence (neck and mediastinum: 48.6%) and bone metastases (22.9%). By univariate analysis, local tumor extension, type of initial surgery, and residual tumor and/or existence of distant metastases at the initial operation were significant factors affecting survival. Stepwise multivariate analysis revealed that invasion of the esophagus and/or carotid artery shortened survival and that multiple surgeries extended survival. Our results suggest that to improve survival in patients with differentiated thyroid cancer, better locoregional control, including multiple surgical resection, is necessary.

TNM stage, immunohistology, syntactic structure analysis and survival in patients with small cell anaplastic carcinoma of the lung

TNM stage, immunostaining with various monoclonal and polyclonal antibodies, analysis of distance of neighboring cells, remission rates, and survival were analyzed in 60 patients suffering from small cell anaplastic carcinoma of the lung. The majority of patients showed advanced tumors at the time of admission to hospital (T2, T3 stage). Distant metastases prior to chemotherapy were detected in 34 patients. Partial remissions lasting 2-4 months were observed in 38 patients, and complete remission was documented in 7 patients. The remission rate was independent of cell type but dependent on the stage of the tumor. Some 30 patients showed positive staining with an antibody recognizing epitopes detectable on carcinoembryonic antigen, whereas 60% of the tumors were positive to a polyclonal neuron-specific enolase antibody. Tissue polypeptide antigen was found to stain positively in 5 cases only. Some 14 patients with negative staining against the monoclonal antibody BMA 406/14 showed prolonged survival compared to patients with positive staining (P less than 0.05). Patients suffering from tumors with smaller distances between neighboring cells had worse prognoses compared to patients with larger distances (P less than 0.01). Survival of patients was found to be indistinguishable if cohorts were grouped according to T stage, N stage, or existence of distant metastases. Ten patients who underwent surgical treatment of tumors did not show prolonged survival compared to 50 patients treated by combined chemotherapy only.

The Management of Chondrosarcoma of Bone

Chondrosarcomas of bone are among the most difficult problems in diagnosis and management in the field of orthopaedic oncology. In addition to the variability of presentation of the "standard" hyaline, myxoid or fibrous types of lesion, three unusual forms of the tumor are now recognized--mesenchymal, clear cell and dedifferentiated--which show differences in their biologic behavior. Chondrosarcomas, with only rare exception, are radio-resistant and show only a limited response to adjunctive chemotherapy. The optimal therapy at present is surgical, but clearly the type of surgical procedure selected should vary with the malignity and extent of the tumor in order to avoid either undertreatment (resulting in a high rate of local recurrence and/or distant metastases) or excessive and unnecessary sacrifice of normal tissue. Patients suspected of having chondrosarcomas should be thoroughly evaluated by clinical examination, radiographic and special studies to define as fully as possible the site and extent of the local tumor, the presence or absence of a soft-tissue mass and the existence of distant metastases. A biopsy should be performed through an incision which can be subsequently excised during the definition procedure. The tissue obtained should be graded histologically and the clinical and radiologic data added to define whether the lesion is benign or a low-grade or high-grade chondrosarcoma. Using a special system recently described by Enneking and Spanier, the lesions should be evaluated on the basis of the grade (G1 or G2); the site of the lesion in relation to the anatomic compartments (T1 or T2) and the presence or absence of distant metastasis (M0 or M1). Based on a scheme presented in this article, the appropriate one of four grades of surgical procedures should be chosen. For benign tumors, Grade I procedures (intralesional curettage or excision) are generally adequate. For Stage IA tumors, occasionally a Grade II procedure, marginal excision may be sufficient, but more frequently Grade III procedures (wide intracompartmental resections) are indicated. Stage IIA and IIB lesions should be treated with Grade III or Grade IV (radical resection) surgical procedures. The treatment of inoperable or Stage IV tumors (those with metastasis) is unsatisfactory and consists of palliative resections, radiation therapy and chemotherapy.