Page 48 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 2
Our study had a number of limitations. We included patients who were treated in ve di erent centers between 1985 and 2013. Over the years, available imaging techniques and treatment modalities have changed and have likely in uenced our results. Moreover, di erent pathologists have assessed tumor grades and margins and these were not re-evaluated, although the grading system for chondrosarcoma is inherently subjective and it has been shown that the interobserver reliability of this classi cation is poor32, 33. However, we only included patients from referral centers with specialized pathologists and, because of the rarity of this disease, multicenter cooperation is necessary to gain su cient power. Further research is needed to develop techniques to reliably determine tumor grade and clinical behavior preoperatively, potentially using molecular markers1. Also, further study should be directed at the role of limited surgical procedures for low-grade chondrosarcoma of the pelvis. Moreover, the exact margin needed to adequately treat pelvic chondrosarcoma, especially grade 1 lesions, will have to be determined in a prospective study.
In conclusion, this study o ers a standard for survival rates for conventional primary central chondrosarcoma of the pelvis. Survival is excellent for patients with a grade 1 tumor and a limited surgical procedure may therefore seem attractive, although we cannot draw conclusions in that regard. However, higher- grade tumors have a substantial risk of disease-related death. We demonstrated that wide resection margins o er a signi cant survival advantage over marginal and intralesional margins for grade 2 and 3 tumors. Because of the inability to reliably distinguish low-grade 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, understanding that 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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