High-risk extracranial chondrosarcoma

Long-term results of surgery and radiation therapy

Authors

  • Jayant Sastri Goda MD,

    1. Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Peter C. Ferguson MD,

    1. Musculoskeletal Oncology Unit at Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Brian O'Sullivan MD,

    1. Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Charles N. Catton MD,

    1. Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Anthony M. Griffin MSc,

    1. Musculoskeletal Oncology Unit at Mount Sinai Hospital, Toronto, Ontario, Canada
    Search for more papers by this author
  • Jay S. Wunder MD,

    1. Musculoskeletal Oncology Unit at Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Robert S. Bell MD,

    1. Musculoskeletal Oncology Unit at Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Rita A. Kandel MD,

    1. Department of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Peter W. Chung MBChB

    Corresponding author
    1. Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
    • Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, M5G 2M9 Canada
    Search for more papers by this author
    • Fax: (416) 946-4442


  • Presented at the 51st Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Chicago, Illinois, November 1-5, 2009.

Abstract

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. Cancer 2011. © 2011 American Cancer Society.

Ancillary