Jun 3, 2015 - HAN-SOO KIM, MD, PhD, SRIMANTH S. BINDIGANAVILE, MS, DNB, AND ILKYU HAN, MD, PhD*. Department of Orthopaedic Surgery, Seoul ...
Journal of Surgical Oncology 2015;111:957–961
Oncologic Outcome After Local Recurrence of Chondrosarcoma: Analysis of Prognostic Factors HAN-SOO KIM,
MD, PhD,
SRIMANTH S. BINDIGANAVILE, MS, DNB,
AND
ILKYU HAN,
MD, PhD*
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
Background: Literature on outcome after local recurrence (LR) in chondrosarcoma is scarce and better appreciation of prognostic factors is needed. Objectives: (1) To evaluate post-LR oncologic outcomes of disease-specific survival and subsequent LR and (2) to identify prognostic factors for post-LR oncologic outcomes. Patients and Methods: Review of 28 patients with locally recurrent chondrosarcoma from the original cohort of 150 patients, who were treated surgically with or without adjuvants between 1982 and 2011, was performed. Mean age was 46 years (range, 21–73) which included 20 males and 8 females with mean follow up of 8.4 7.5 years (range, 1.2–31.0). Results: Post-LR survival at 5 years was 58.6 10.3%. Age greater than 50 years (P ¼ 0.011) and LR occurring within 1 year of primary surgery (P ¼ 0.011) independently predicted poor survival. Seven patients suffered subsequent LR, which was significantly affected by surgical margin for LR (P ¼ 0.038). Conclusion: Long-term survival of locally recurrent chondrosarcoma is achievable in a substantial number of patients. Older age at onset of LR and shorter interval from primary surgery to LR identifies high risk patients for poor post-LR survival while, wide surgical margins at LR surgery reduces the risk of subsequent LR.
J. Surg. Oncol. 2015;111:957–961. © 2015 Wiley Periodicals, Inc.
KEY WORDS: chondrosarcoma; local recurrence; grade; axial; metastasis
INTRODUCTION Because of the limited effects of radiation therapy and chemotherapy, surgery remains the primary treatment modality for local control of chondrosarcoma either for primary or locally recurrent cases [1–4]. Surgical treatment of locally recurrent chondrosarcoma is especially challenging because of the altered anatomy and scarring from the previous surgery, which may result not only in the compromise of the surgical margin but also in significant morbidity of the patient [5,6]. In general, the development of local recurrence (LR) is thought to be associated with increased rate of metastasis and worse survival in chondrosarcoma [3,7,8]. However, literature on outcome after LR in chondrosarcoma is scarce [4,9] with the reported wide range of survival rate from 17% to 76% at 10–20 years [1,8,10]. Moreover, better identification of prognostic factors is needed to guide decisions regarding treatment and surveillance in locally recurrent chondrosarcoma. This study was undertaken in a series of locally recurrent chondrosarcomas treated in a single institution, 1) to evaluate postLR oncologic outcomes of disease-specific survival and subsequent LR and 2) to identify prognostic factors for post-LR oncologic outcomes.
MATERIALS AND METHODS From the prospectively collected database of our institute, 150 consecutive patients who had undergone surgery for chondrosarcoma of extremities or pelvis from 1988 to 2011 were reviewed. Among these 150 patients, we identified 40 (26%) patients who were diagnosed with LR. LR was defined as the first recurrence of disease at the site of the primary tumor, occurring after at least 3 months after surgery. Of these 40 patients, 32 patients had their primary tumors removed at our institute and 8 patients were referred to our institute after first LR. When diagnosed with LR, patients underwent resection of LR unless a contraindication existed. Contraindications included unresectable
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diseases or the presence of significant comorbid disease to tolerate surgery. Thirty-seven of these 40 patients underwent surgical treatment for LR. Among these 37 patients, 5 patients with a follow-up duration shorter than 1 year after LR and 4 patients with low grade chondrosarcoma of the extremities were excluded, which left 28 patients for analysis. The mean follow-up duration of all patients was 8.4 7.5 years (range, 1.2–31.0). The mean follow-up duration of survivors was 11.1 years (range, 3.0–31.0). The institutional review board of our institute approved this study. Medical records were reviewed for the potential clinic-pathologic variables that might influence post-LR oncologic outcome in chondrosarcoma: (1) patient demographics, (2) factors related to the primary tumor, (3) pattern of LR, and (4) treatment of LR. For demographic data, patients’ gender and age were investigated. There were 20 males and 8 females (Table I). The mean age at the time of LR was 46 years (range, 21–73 years). The patients’ age were dichotomized as
