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Chondrosarcoma of the mobile spine: a review of 21 cases treated at a single center
Andrew J Schoenfeld1, Francis J Hornicek, Francis X Pedlow
1Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
Study Design:
Retrospective case series.
Objective:
To determine the effect of modern surgical and aggressive radiation techniques on outcome in patients with spinal chondrosarcoma.
Summary Of Background Data:
Chondrosarcoma of the spine presents a difficult surgical challenge. Surgical excision is considered the standard of care, yet complete excision is not always feasible, and rates of local control and survival are inferior to those reported for the extremities.
Methods:
We performed a retrospective review of cases of chondrosarcoma involving the spine above the sacrum treated surgically at our institution between 1984 and 2006. Medical charts, radiology reports, pathology reports, and operative notes were reviewed for all patients. Available imaging studies were also reviewed. The Student t test and Fisher exact test were used to compare baseline differences between groups. Survivorship analysis was performed using Kaplan-Meier methodology. Overall survival was calculated on the basis of en bloc resection, margins, local recurrence, and metastasis.
Results:
Twenty-one patients were treated surgically for chondrosarcoma of the mobile spine. Twenty of the 21 patients were also treated with radiation with a mean dose of 71 Gy (range, 53-83). The average overall survival for all patients in our series was 120.5 months (SE = 32.9; range, 8.5-298.9 months). The 1- and 5-year survival rates for all patients were 90% and 61%, respectively. Patients treated with en bloc resection had a better overall survival (198 months: SE = 24.5; range, 24-224.7 months) than those who underwent intralesional excision (77 months: SE = 27.3; range, 8.5-298.9 months) (P = 0.05). Five (24%) patients developed local recurrence and 9 (43%) developed metastasis. All recurrences occurred in patients who underwent intralesional resection. Metastasis, high-grade tumor, and positive surgical margins were associated with worse overall survival (P < 0.001, 0.02, and 0.04, respectively).
Conclusion:
In this series, en bloc resection, the absence of metastasis, low-grade tumors, and negative margins were associated with improved overall survival. The aggressive use of sophisticated surgical and radiation techniques appears to confer an advantage to patients, decreasing local recurrence and increasing overall survival, even following incomplete surgical resection.