Zoccali Carmine, Baldi Jacopo, Attala Dario, Rossi Barbara, Anelli Vincenzo, Annovazzi Alessio, Ferraresi Virginia
Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
Oncological Orthopaedics Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
Arch Orthop Trauma Surg. 2018 Jul;138(7):929-937. doi: 10.1007/s00402-018-2930-0. Epub 2018 Apr 10.
Chondroid lesions are very common bone tumors. In most cases, they are benign enchondromas (EC) and, in a minor percentage, chondrosarcomas (CSs), the malignant counterpart. In the latter cases, surgery is the mainstay treatment, because they are chemo- and radio-resistant unless dedifferentiation occurs. If resection is recognized as the gold standard for intermediate-, high-grade tumors, and for low-grade chondrosarcoma (LG-CS) located in the spine and pelvis to reduce the risk of local recurrence, there is still no consensus in literature on the treatment of central low-grade chondrosarcoma (cLG-CS) located in the limbs. Our aim is to perform a review of literature on evidence supporting this approach or not.
An electronic research of the medical archives was carried out in March 2017 seeking papers evaluating the results of curettage and resection in cLG-CS.
We selected 13 studies corresponding to our criteria. Unfortunately, they were descriptive, retrospective, non-randomized studies. We identified a population of 471 patients for a total of 473 low-grade chondrosarcomas. Two hundred and ninety-nine lesions were treated with curettage and 174 with wide surgery. The two groups were not homogeneous for diagnosis, size and staging, so no comparison between resection and curettage was possible. The global weighted average percentage of local recurrence was 6.7% (20 cases) and 10.9% (19 cases) after curettage and resection, respectively. No cases of metastasis were reported in the group treated with intralesional surgery, compared to five cases reported in the group treated with resection. Indications for surgery were given in most cases based on symptoms and imaging.
The absence of a preoperative histological diagnosis and the lack of a scientific method to conduct the studies do not sufficiently support curettage for low-grade chondrosarcomas. In the absence of this, resection must be considered a general rule for every malignancy. In our opinion, based on the low biological growth rate of low-grade chondrosarcoma, every chondromatous lesion can be followed-up. Biopsies must be performed based on clinical and radiological suspicions such as pain, scalloping or increase in size, rather than on performing a PET scan to evidence more informative high metabolic areas.
软骨样病变是非常常见的骨肿瘤。在大多数情况下，它们是良性内生软骨瘤（EC），少数情况下是其恶性对应物软骨肉瘤（CS）。在后一种情况下，手术是主要的治疗方法，因为除非发生去分化，否则它们对化疗和放疗具有抗性。如果切除被认为是治疗中级和高级别肿瘤以及位于脊柱和骨盆的低级别软骨肉瘤（LG-CS）以降低局部复发风险的金标准，那么对于位于四肢的中央型低级别软骨肉瘤（cLG-CS）的治疗，文献中仍未达成共识。我们的目的是对支持或不支持这种治疗方法的文献证据进行综述。
2017年3月对医学档案进行了电子检索，寻找评估cLG-CS刮除术和切除术结果的论文。
我们选择了13项符合我们标准的研究。不幸的是，它们都是描述性的、回顾性的、非随机研究。我们确定了471例患者，共473个低级别软骨肉瘤。299个病变采用刮除术治疗，174个采用广泛手术治疗。两组在诊断、大小和分期方面不一致，因此无法对切除术和刮除术进行比较。刮除术和切除术后局部复发的总体加权平均百分比分别为6.7%（20例）和10.9%（19例）。病灶内手术治疗组未报告转移病例，而切除术治疗组报告了5例。大多数情况下，手术指征是根据症状和影像学检查确定的。
缺乏术前组织学诊断以及缺乏科学的研究方法不足以支持对低级别软骨肉瘤进行刮除术。在没有这些的情况下，对于每种恶性肿瘤，切除都应被视为一般原则。我们认为，基于低级别软骨肉瘤的低生物学生长率，每个软骨瘤样病变都可以进行随访。活检应基于临床和放射学怀疑进行，如疼痛、扇贝样改变或大小增加，而不是基于进行PET扫描以发现更多信息丰富的高代谢区域。
