Long-term results of intralesional curettage and cryosurgery for treatment of low-grade chondrosarcoma.
BACKGROUND
Data regarding outcomes following intralesional curettage and cryosurgical treatment of low-grade chondrosarcoma of bone are limited. The aim of this study was to assess the long-term oncologic and functional outcomes of two different cryosurgery techniques.


METHODS
Forty-three low-grade chondrosarcoma lesions (in forty-two patients) were treated with intralesional curettage and cryosurgery from June 1983 to October 2006. Eleven lesions were treated with cryoprobes and thirty-two were treated with the modified direct-pour Marcove technique. The mean patient age was 44.9 ± 11.3 years (range, 21.8 to 66.4 years), and the mean duration of follow-up was 10.2 ± 4.6 years (range, five to 22.5 years). Indications for treatment included a radiographic appearance consistent with a cartilage tumor with evidence of aggressive behavior. Pearson correlation and multivariate analyses were used to evaluate the relationships between predictive factors (including lesion size, soft-tissue extension, and location, patient age, cortical erosion, and presence of preoperative pain) and outcomes.


RESULTS
The mean overall Musculoskeletal Tumor Society (MSTS) score was 26.5 ± 3.1 (range, 17 to 30). There were four local recurrences, all in patients who had had tumor extension out of the bone with soft-tissue involvement at initial presentation. The mean time to recurrence was 2.4 ± 2.3 years (range, 0.6 to 5.6 years). No patients developed metastatic disease during the follow-up period. There were no differences between the cryoprobe and Marcove techniques with respect to the MSTS score, fracture, or local recurrence. A significant correlation between tumor recurrence and soft-tissue extension was found (r = 0.79). Kaplan-Meier survivorship, with freedom from recurrence as the end point, was 90.7%.


CONCLUSIONS
Intralesional curettage and cryosurgery for low-grade chondrosarcoma is safe and effective in selected patients. The presence of preoperative cortical breakthrough and soft-tissue extension was the strongest predictor of local recurrence following use of this technique.


METHODS
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
Washington Cancer Institute, Washington Hospital Center, Georgetown University, 110 Irving Street N.W., Room CI-2158, Washington, DC 20010, USA. MeftahM@HSS.edu
Morteza
M
Meftah
Patricia
P
Schult
Robert M
RM
Henshaw
D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002813:Chondrosarcoma / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods; D003475:Curettage; D005598:Fractures, Spontaneous / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult