Page 45 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Table 3. The risk of local recurrence and metastasis in relation to tumor grade and resection margins.
Pelvic chondrosarcoma
Total Recurrence Metastases
NN%N%
Grade 1 Wide
Marginal
Intralesional Grade 2
Wide Marginal Intralesional
Discussion
220 - 2 25 0 -
441 11
18 12 24 447 30 63 11 58
484 17 86 6 86 567 78
Grade 3 Wide
9 2 12 3 9 4
51 9 23 10 19 12
23 11 Marginal 7 6 Intralesional 9 5
In this multicenter study, we evaluated oncological outcome, risk factors for impaired survival, and postoperative complications in 162 patients who underwent resection of a pelvic conventional primary central chondrosarcoma. Pelvic chondrosarcomas are notoriously di cult to treat and are more often of high grade, and treatment has been associated with worse outcomes than those of extremity chondrosarcoma16,24,28. Thirty-four percent of our patients died of disease. Others series on pelvic chondrosarcoma have shown that 20% to 36% of patients died of disease4,16,20,21, but these included di erent subtypes and primary central lesions appear to have a worse prognosis than secondary peripheral tumors4,19,21,22.
In concordance with previous studies, tumor grade was the most important prognostic factor for patient survival4, 16, 19, 21, 22, 29 (table 5). Of the patients with a grade 1 lesion on the resection specimen, only one (3%) died of disease. Limited surgery may seem attractive for these low-grade pelvic chondrosarcomas, given the excellent survival rates and the favorable clinical outcome reported for curettage of low-grade extremity chondrosarcoma7. However, several problems remain to be solved. First, recurrent tumors can be of higher grade than the initial lesion, and recurrence may be regarded as a declaration of a more aggressive subtype4, 5, 30, 31. In the current series, four recurrences (6% of 62) were of higher grade than the initial tumor. Second, some lesions appear to be grade I on the biopsy specimen, but they sometimes have a higher grade when later examined on the resected specimen32, 33. Third,
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