Rascoe Philip A, Reznik Scott I, Smythe W Roy
Scott & White Memorial Hospital and Clinic and Olin E. Teague Veterans' Center, Texas A&M Health Science Center College of Medicine, Temple, TX 76508, USA.
Sarcoma. 2011;2011:342879. doi: 10.1155/2011/342879. Epub 2011 May 11.
Although a rare entity, chondrosarcoma is the most common malignant tumor of the chest wall. Most patients present with an enlarging, painful anterior chest wall mass arising from the costochondrosternal junction. CT scan with intravenous contrast is the gold standard radiographic study for diagnosis and operative planning. Contrary to previous dictum, resection may be performed in an appropriate surgical candidate based on imaging characteristics or image-guided percutaneous biopsy results; incisional biopsy is rarely required. The keys to successful treatment are early recognition and radical excision with adequate margins, as chondrosarcoma is relatively resistant to radiotherapy and conventional cytotoxic chemotherapy. Overall survival is excellent in most surgical series from experienced centers. Complete excision with widely negative microscopic margins at the initial operation is of the utmost importance, as local recurrence portends systemic metastasis and eventual tumor-related mortality. This paper summarizes data from relevant surgical series and thereupon draws conclusions regarding preoperative, intraoperative, and postoperative management of thoracic chondrosarcoma.
软骨肉瘤虽然是一种罕见的疾病，但却是胸壁最常见的恶性肿瘤。大多数患者表现为起源于肋软骨胸骨交界处的、不断增大且疼痛的前胸壁肿块。静脉注射造影剂的CT扫描是用于诊断和手术规划的金标准影像学检查。与以往的观点相反，根据影像学特征或影像引导下经皮穿刺活检结果，合适的手术候选者可进行切除；很少需要进行切开活检。成功治疗的关键是早期识别并进行有足够切缘的根治性切除，因为软骨肉瘤对放疗和传统细胞毒性化疗相对耐药。在大多数来自经验丰富中心的手术系列中，总体生存率良好。初次手术时完整切除且显微镜下切缘广泛阴性至关重要，因为局部复发预示着全身转移及最终与肿瘤相关的死亡。本文总结了相关手术系列的数据，并据此得出关于胸段软骨肉瘤术前、术中和术后管理的结论。
