Is surgery alone sufficient to control chondrosarcomas?

Aims To determine the effectiveness of surgery only in the management of chondrosarcoma (CS) and to identify prognostic factors on local control and survival. Methods We realised a retrospective study during 20 years. It concerned 65 patients with localized CS and treated surgically only. The minimum follow up was one year. Grade I CS was considered as low grade and the other subtypes as high grades. Results There were 33 male and 32 female patients with a median age of 37. Forty nine lesions (75.4%) were primary. Patients with secondary CS were younger (median age 33 vs 45, p = 0.03). Forty five lesions (69.2%) were located in the appendicular skeleton. There were 23 grade I CS (35.4%), 25 grade II (38.5%), 14 grade III (21.6%), one dedifferentiated CS (1.5%) and 2 mesenchymal CS (3%). Surgical margins were intralesional (IL) in 15 cases (23.1%), marginal (M) in 12 cases (18.5%), wide (W) in 30 cases (46.2%) and radical (R) in 8 cases (12.3%). In the last follow up 37 patients (56.9%) were free from disease, 4 patients (6.2%) had lung metastasis and 24 patients (36.9%) had died. Twenty patients (30.8%) developed local recurrence (LR). The factor which was significantly associated with a high rate of LR was surgical margins. Patients with high grade lesions had a significant higher risk of metastases (42.2% vs 0%, p < 0.001) Conclusion Adequate surgical margins is paramount in CS since surgery is the only effective treatment. Inadequate margins lead to high risk of recurrence and progression of the tumor grade. Adequate margins are sufficient only in low grade tumors. High grade lesions should be considered as a systemic disease and may need further oncologic therapy.