Washington Cancer Institute, Washington Hospital Center, Georgetown University, 110 Irving Street N.W., Room CI-2158, Washington, DC 20010, USA.
J Bone Joint Surg Am. 2013 Aug 7;95(15):1358-64. doi: 10.2106/JBJS.L.00442.
Data regarding outcomes following intralesional curettage and cryosurgical treatment of low-grade chondrosarcoma of bone are limited. The aim of this study was to assess the long-term oncologic and functional outcomes of two different cryosurgery techniques.
Forty-three low-grade chondrosarcoma lesions (in forty-two patients) were treated with intralesional curettage and cryosurgery from June 1983 to October 2006. Eleven lesions were treated with cryoprobes and thirty-two were treated with the modified direct-pour Marcove technique. The mean patient age was 44.9 ± 11.3 years (range, 21.8 to 66.4 years), and the mean duration of follow-up was 10.2 ± 4.6 years (range, five to 22.5 years). Indications for treatment included a radiographic appearance consistent with a cartilage tumor with evidence of aggressive behavior. Pearson correlation and multivariate analyses were used to evaluate the relationships between predictive factors (including lesion size, soft-tissue extension, and location, patient age, cortical erosion, and presence of preoperative pain) and outcomes.
The mean overall Musculoskeletal Tumor Society (MSTS) score was 26.5 ± 3.1 (range, 17 to 30). There were four local recurrences, all in patients who had had tumor extension out of the bone with soft-tissue involvement at initial presentation. The mean time to recurrence was 2.4 ± 2.3 years (range, 0.6 to 5.6 years). No patients developed metastatic disease during the follow-up period. There were no differences between the cryoprobe and Marcove techniques with respect to the MSTS score, fracture, or local recurrence. A significant correlation between tumor recurrence and soft-tissue extension was found (r = 0.79). Kaplan-Meier survivorship, with freedom from recurrence as the end point, was 90.7%.
Intralesional curettage and cryosurgery for low-grade chondrosarcoma is safe and effective in selected patients. The presence of preoperative cortical breakthrough and soft-tissue extension was the strongest predictor of local recurrence following use of this technique.
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
关于骨内部分切除术和冷冻治疗低度软骨肉瘤的结果数据有限。本研究的目的是评估两种不同冷冻技术的长期肿瘤学和功能结果。
1983 年 6 月至 2006 年 10 月，对 42 例患者的 43 个低度软骨肉瘤病变进行了内部分切除术和冷冻治疗。11 个病变采用冷冻探针治疗，32 个病变采用改良直接倾洒 Marcove 技术治疗。患者平均年龄为 44.9 ± 11.3 岁（范围为 21.8 岁至 66.4 岁），平均随访时间为 10.2 ± 4.6 年（范围为 5 年至 22.5 年）。治疗的适应证包括影像学表现符合软骨肿瘤，且具有侵袭性行为的证据。采用 Pearson 相关性和多变量分析评估预测因素（包括病变大小、软组织延伸和位置、患者年龄、皮质侵蚀和术前疼痛存在）与结果之间的关系。
平均总体肌肉骨骼肿瘤学会（MSTS）评分为 26.5 ± 3.1（范围为 17 至 30）。有 4 例局部复发，均发生在初始表现为肿瘤超出骨并伴有软组织受累的患者中。复发的平均时间为 2.4 ± 2.3 年（范围为 0.6 年至 5.6 年）。在随访期间，无患者发生转移性疾病。冷冻探针和 Marcove 技术在 MSTS 评分、骨折或局部复发方面无差异。肿瘤复发与软组织延伸之间存在显著相关性（r = 0.79）。以无复发为终点的 Kaplan-Meier 生存分析显示，无复发率为 90.7%。
在选择的患者中，骨内部分切除术和冷冻治疗低度软骨肉瘤是安全有效的。术前皮质突破和软组织延伸是该技术应用后局部复发的最强预测因素。
治疗性 IV 级。请参阅作者说明以获取完整的证据水平描述。
