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Chondrosarcoma of Bone: Survival Analysis and Prognostic Factors in a Series of 155 Patients Treated at a Single Institution. 15 th Annual CTOS Meeting, Miami Beach, FL. Per-Ulf Tunn, D. Andreou , S. Fehlberg, M. Werner, P. Reichardt. Department of Orthopedic Oncology Chair: P.-U. Tunn, MD

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per ulf tunn d andreou s fehlberg m werner p reichardt

Chondrosarcoma of Bone: Survival Analysis and Prognostic Factors in a Series of 155 Patients Treated at a Single Institution

15th Annual CTOS Meeting, Miami Beach, FL

Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt

Department of Orthopedic Oncology

Chair: P.-U. Tunn, MD

Sarcoma Center Berlin-Brandenburg

HELIOS Klinikum Berlin-Buch, Germany

chondrosarcoma of bone
Chondrosarcoma of bone
  • resistant to standard CT or RT
  • cornerstone of treatment:

 adequate surgery

  • novel therapeutic approaches:
    • tyrosine kinase inhibitors
    • bisphosphonates
    • proton beam radiotherapy

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

patients and methods
Patients and Methods
  • study design: retrospective analysis
  • number of patients: 155 (94 men, 61 women)
  • time period: 1975 - 2005
  • mean age: 47.8 years (range, 12 – 79)
  • mean follow-up: 79.9 months (range, 6 – 337)

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

patients and methods4
Patients and Methods
  • tumor localization: lower extremity n = 62

pelvic girdle n = 54

upper extremity n = 29

axial skeleton n = 10

  • mean tumor volume: 470.0 cm3(range, 0.2 to 8424)
  • pathological fracture: lower extremity n = 8

upper extremity n = 5

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

patients and methods5
Patients and Methods
  • grading: G1 n = 75

G2 n = 56

G3 n = 24

  • surgical treatment: limb-sparing n = 100

ablative n = 45

  • surgical margins: wide n = 121

marginal n = 8

intralesional n = 26

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results
Results

Overall survival

Event-free survival

Time in months

Time in months

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results tumor localization
Results – tumor localization

Overall survival

Event-free survival

extremities (CE)

CE

axial skeleton

and pelvis (CAP)

CAP

Time in months

Time in months

p = 0.075

p = 0.114

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results age and gender
Results – age and gender

Overall survival

Overall survival

age ≤ 40

women

men

age > 40

Time in months

Time in months

p < 0.001

p = 0.295

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results local recurrence
Results – local recurrence

Overall survival

Overall survival

CE – no local

recurrence

CAP – no local recurrence

CE – local recurrence

CAP – local recurrence

Time in months

Time in months

p < 0.001

p = 0.017

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results metastasis
Results – metastasis

Overall survival following

metastatic disease

Overall survival

no metastasis

further treatment

best supportive care

metastasis

Time in months

Time in months

p < 0.001

p = 0.002

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results tumor grading
Results – tumor grading

Overall survival

Event-free survival

G1

G1

G2

G2

G3

G3

Time in months

Time in months

p < 0.001

p < 0.001

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results tumor grading12
Results – tumor grading

Overall survival – CAP

Overall survival – CE

G1

G1

G2

G2

G3

G3

Time in months

Time in months

p = 0.107

G1 vs. G3: p = 0.034

p < 0.001

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results pathological fracture
Results – pathological fracture

lower extremity

Overall survival

p < 0.001

no pathological fracture

upper extremity

pathological fracture

Time in months

p = 0.747

p = 0.028

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results surgical margins
Results – surgical margins

CAP group

Overall survival

marginal

intralesional

p < 0.001

p = 0.530

CE group

wide

Time in months

p = 0.409

p = 0.747

p = 0.422

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results surgical margins15
Results – surgical margins

CAP group

Event-free survival

p = 0.036

wide

CE group

marginal

intralesional

Time in months

p = 0.109

wide vs. intralesional: p = 0.019

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results tumor stage
Results – tumor stage

Overall survival

Event-free survival

IA

IB

IA

IIA

IIA

IB

IIB

IIB

Time in months

Time in months

p = 0.001

p = 0.012

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

results tumor stage17
Results – tumor stage

Overall survival – CE group

Overall survival – CAP group

IA

IIA

IB

IA

IB

IIB

IIB

IIA

Time in months

Time in months

p < 0.001

p = 0.166

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

conclusions negative prognostic factors
Conclusions – negative prognostic factors
  • age over 40
  • local recurrence
  • systemic metastasis
  • high grade
  • pathological fracture at diagnosis (lower extremity)

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

conclusions quality of surgical margins
Conclusions – quality of surgical margins
  • no influence on overall survival
  • decreased event-free survival for intralesional resections only in patients with tumors of the axial skeleton or pelvis
  •  intralesional resections of otherwise inoperable tumors could be justified

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany

conclusions ajcc staging system
Conclusions – AJCC staging system
  • no correlation with oncological outcome in patients with tumors of the axial skeleton or pelvis
  • if these results are confirmed in other studies, the development of a separate staging system for these tumors might be warranted

Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany