Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt Department of Orthopedic Oncology Chair: P.-U. Tunn, MD Sarcoma Center Berlin-Brandenburg

Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt

Department of Orthopedic OncologyChair: P.-U. Tunn, MD

Sarcoma Center Berlin-BrandenburgHELIOS Klinikum Berlin-Buch, Germany

Chondrosarcoma of Bone: Survival Analysis and Prognostic Factors in a Series of 155 Patients

Treated at a Single Institution

15th Annual CTOS Meeting, Miami Beach, FL

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

Chondrosarcoma of bone

• resistant to standard CT or RT

• cornerstone of treatment:

adequate surgery

• novel therapeutic approaches:

- tyrosine kinase inhibitors

- bisphosphonates

- proton beam radiotherapy


Patients and Methods

• study design: retrospective analysis

• number of patients: 155 (94 men, 61 women)

• time period: 1975 - 2005

• mean age: 47.8 years (range, 12 – 79)

• mean follow-up: 79.9 months (range, 6 – 337)



• tumor localization: lower extremity n = 62

pelvic girdle n = 54

upper extremity n = 29

axial skeleton n = 10

• mean tumor volume: 470.0 cm3 (range, 0.2 to 8424)

• pathological fracture: lower extremity n = 8

upper extremity n = 5



• grading: G1 n = 75

G2 n = 56

G3 n = 24

• surgical treatment: limb-sparing n = 100

ablative n = 45

• surgical margins: wide n = 121

marginal n = 8

intralesional n = 26


Results

Overall survival

Time in months

Event-free survival

Time in months


Results – tumor localization

Overall survival

Time in months

Event-free survival

Time in months

p = 0.075 p = 0.114

extremities (CE)

axial skeletonand pelvis (CAP)

CE

CAP


Results – age and gender

Overall survival

Time in months

Overall survival

Time in months

p < 0.001 p = 0.295

age ≤ 40

age > 40

women

men


Results – local recurrence

Overall survival

Time in months

Overall survival

Time in months

p < 0.001 p = 0.017

CAP – no local recurrence

CAP – local recurrence

CE – no local recurrence

CE – local recurrence


Results – metastasis

Overall survival

Time in months

Overall survival followingmetastatic disease

Time in months

p < 0.001 p = 0.002

no metastasis

metastasis

further treatment

best supportive care


Results – tumor grading

Overall survival

Time in months

Event-free survival

Time in months

p < 0.001 p < 0.001

G1

G2

G3

G1

G2

G3


Results – tumor grading

Overall survival – CAP

Time in months

Overall survival – CE

Time in months

p = 0.107 p < 0.001G1 vs. G3: p = 0.034

G1

G2

G3

G1

G2

G3


Results – pathological fracture

Overall survival

Time in months

p = 0.028

no pathological fracture

pathological fracture

lower extremity

upper extremity

p < 0.001

p = 0.747


Results – surgical margins

Overall survival

Time in months

p = 0.422

p < 0.001

p = 0.747

marginalintralesional

wide

p = 0.530

CAP group

CE group

p = 0.409


Results – surgical margins

Event-free survival

Time in months

wide vs. intralesional: p = 0.019

CE group

p = 0.109

CAP group

p = 0.036wide

marginal

intralesional


Results – tumor stage

Overall survival

Time in months

Event-free survival

Time in months

p = 0.001 p = 0.012

IA

IBIIA

IIB

IA

IB

IIA

IIB


Results – tumor stage

Overall survival – CE group

Time in months

Overall survival – CAP group

Time in months

p < 0.001 p = 0.166

IA

IB

IIA

IIB

IA IBIIA

IIB


Conclusions – negative prognostic factors

• age over 40

• local recurrence

• systemic metastasis

• high grade

• pathological fracture at diagnosis (lower extremity)


Conclusions – quality of surgical margins

• no influence on overall survival

• decreased event-free survival for intralesional resections

only in patients with tumors of the axial skeleton or pelvis

intralesional resections of otherwise inoperable tumors

could be justified


Conclusions – AJCC staging system

• no correlation with oncological outcome in patients with

tumors of the axial skeleton or pelvis

• if these results are confirmed in other studies, the

development of a separate staging system for these

tumors might be warranted

Documents

Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt Department of Orthopedic Oncology Chair: P.-U. Tunn, MD Sarcoma Center Berlin-Brandenburg