title: Chondrosarcomas of the cervical and cervicothoracic spine: surgical management and long-term clinical outcome.
abstract: METHODS
  A retrospective review study.
  
  
  OBJECTIVE
  To estimate the clinical outcome of various resection protocols in patients with chondrosarcoma (CHS) at the challenging region of cervical and cervicothoracic spine (CCT).
  
  
  BACKGROUND
  It is challenging to surgically manage CHS of the spine. Although total en-bloc resection has proven to be an ideal treatment, this option is not always feasible in the spine because of the constrains of critical neurovascular structures in the vicinity. Lesions at the CCT region pose even more difficulties, and few large clinical series concerning various protocols and long-term outcomes of these lesions exist at present.
  
  
  METHODS
  Fifteen patients with CHS at the CCT region who underwent surgical management in our institute were retrospectively studied. Twelve piecemeal resections and 3 en-bloc resections were performed. Intraoperative local chemotherapy and postoperative cyberknife radiotherapy were given as adjuvant therapy. Neurologic status, local recurrence, distant metastasis, and treatment-related complications were evaluated.
  
  
  RESULTS
  The mean follow-up time was 58.7 months (median 37 mo; ranging from 18 to 141 mo). Local recurrence was detected in 5 of 5 cases (100%) treated by intracapsular piecemeal resection, and in 1 of 7 cases (14.3%) treated by extracapsular piecemeal resection, whereas no recurrence was found in 3 cases treated by en-bloc resection. Of the 6 recurrent patients, 5 died of disease 24 to 46 months after present surgery, and the remaining patient was alive with disease in the final follow-up. There were no signs of recurrence in the remaining 9 patients.
  
  
  CONCLUSIONS
  For CHS at the CCT region, intralesional piecemeal resection has a poor prognosis and should be avoided. Oncologically, en-bloc resection remains the best form of disease management and should be the primary treatment of choice. For cases in which an uncontaminated en-bloc resection could not be achieved, the extracapsular piecemeal resection with adjuvant therapy including local chemotherapy and cyberknife radiotherapy is an effective and achievable option.
authors.affiliation: The Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China. cnspineyang@yahoo.com.cn
authors.forename: Xinghai
authors.initials: X
authors.lastname: Yang
authors.forename: Zhipeng
authors.initials: Z
authors.lastname: Wu
authors.forename: Jianru
authors.initials: J
authors.lastname: Xiao
authors.forename: Dapeng
authors.initials: D
authors.lastname: Feng
authors.forename: Quan
authors.initials: Q
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.forename: Huajiang
authors.initials: H
authors.lastname: Chen
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
authors.forename: Lianshun
authors.initials: L
authors.lastname: Jia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002813:Chondrosarcoma / Q000000981:diagnostic imaging / Q000601:surgery*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult