Page 34 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 2
Abstract
Background: Studies focusing on the oncological outcome after treatment of conventional primary central chondrosarcoma of pelvic bone are lacking. We conducted this retrospective study at ve referral centers to gain insight in the outcome of treatment for this tumor type and to identify risk factors for impaired oncological outcome.
Patients and Methods: 162 consecutive patients (118 males, 73%) who underwent resection of a conventional primary central chondrosarcoma of pelvic bone from 1985-2013 were evaluated. The median age was 51 years (15-78). The median follow-up was 12.6 years (95% con dence interval [CI], 8.4 - 16.9). There were 30 grade 1 lesions (19%), 93 grade 2 lesions (57%), and 39 grade 3 lesions (24%).
Results: Sixty-two patients (38%) experienced local recurrence: nine grade 1 lesions (30%), 31 grade 2 lesions (33%) and 22 grade 3 lesions (56%). Forty-eight patients (30%) developed metastases. The risk of disease-related death was 3% for grade 1 tumors (1 of 30; this patient had a grade 2 recurrence and died of metastases), 33% (31 of 93) for grade 2 tumors, and 54% (21 of 39) for grade 3 tumors. Identi ed risk factors for impaired disease-speci c survival were tumor grade (grade 2, hazard ratio [HR] 20.18, p=0.003; grade 3, HR 58.93, p<0.001), resection margins (marginal, HR 3.21, p=0.001; intralesional, HR 3.56, p<0.001) and maximal tumor size (HR 1.08 per cm, p=0.026). Deep infection (n=31, 19%) was the predominant complication.
Conclusions: This study o ers a standard for survival rates for conventional primary central chondrosarcoma of the pelvis. The survival for grade 1 tumors was excellent. Wide resection margins were associated with a signi cant survival advantage for higher-grade tumors. Because of the inability to reliably distinguish low- and high- grade tumors preoperatively, we conclude that any central pelvic chondrosarcoma should be treated with aggressive primary resection with the aim of obtaining wide resection margins. There may be aggressive biologic features in some tumors for which a surgical procedure alone may not be adequate to improve outcomes.
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