High-risk extracranial chondrosarcoma: long-term results of surgery and radiation therapy.
BACKGROUND
A study was undertaken to evaluate results of surgery and radiotherapy (RT) for high-risk extracranial chondrosarcomas.


METHODS
Between 1986 and 2006, 60 patients underwent surgery and RT for extracranial high-risk chondrosarcoma. Preoperative RT (median, 50 gray [Gy]) and postoperative RT (median, 60 Gy) were used in 40% and 60% patients, respectively. Sites included pelvis/lower extremity (48%), chest wall (22%), spine/paraspinal (17%), and head and neck (13%). Overall, median tumor size was 7 cm (range, 1-22 cm), and tumor grade was I, II, and III in 22%, 64%, and 14% of cases, respectively.


RESULTS
Pathologically clear surgical margins (R0) were present in 50%, microscopic positive margins (R1) in 28%, and gross positive margins (R2) in 13%, half of whom had clinically detectable residual disease; surgical margin was unknown in 8%. Median follow-up was 75 months (range, 5-230 months). The crude local control rate was 90%. Patients with R0, R1, and R2 resections had local control of 100%, 94%, and 42%, respectively. Of the 8 cases that had R2 resection, 3 experienced uncontrolled progression, but 5 patients had stable disease with long-term follow-up. The 10-year overall survival, progression-free survival, and cause-specific survival were 86%, 80.5%, and 89.4%, respectively. Younger age and grade III tumors were associated with worse progression-free survival (P = .03 and .0003, respectively).


CONCLUSIONS
Although surgery with complete resection is paramount in management of chondrosarcoma, RT is a useful adjuvant treatment and appears to offer excellent and durable local control where wide surgical resection is difficult to accomplish.
Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
Jayant Sastri
JS
Goda
Peter C
PC
Ferguson
Brian
B
O'Sullivan
Charles N
CN
Catton
Anthony M
AM
Griffin
Jay S
JS
Wunder
Robert S
RS
Bell
Rita A
RA
Kandel
Peter W
PW
Chung
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D002813:Chondrosarcoma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012008:Recurrence; D016879:Salvage Therapy; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult