Soft-tissue Chondrosarcoma and recurrent disease - Dushan Atkinson November 2007 FRCS Tr & Orth

A review of the literature concerning the risk of developing any metastasis from Grade II histological grade chondrosarcoma which has undergone wide excision, is extremely low.

1)   Uchida Y, Kawai A, Taguchi K, Yokoi T, Pu J, Inoue H, Clinicopathology of chondrosarcoma, Acta Med Okayama. 1996 Aug;50(4):191-6

Of 17 patients treated at their institution, NO patients wih Grade I or II disease developed any metastases, while those patients with Grade III chondrosarcomas or de-differentiated chondrosarcomas ALL had metastases only to the lung.

Those patients who underwent wide excision of the tumour did not get local recurrence either.

2) Wang JW, Ger LP, Shih CH, Hsieh MC. Chondrosarcoma of bone: a statistical analysis of prognostic factors. J Formos Med Assoc. 1991 Oct;90(10):998-1003.

100% of Grade I and II patients survived 8.7 years post surgery; and NO patient had metastases over this period.   This was not the case in Grade III diseased patients.

Often misquoted,

Wroñski M, Arbit E, Burt M, Perino G, Galicich JH, Brennan MF,     Resection of brain metastases from sarcoma, Ann Surg Oncol. 1995 Sep;2(5):392-9.

Looked at 670 patients with brain metastases of whom 28 had had a bone or soft-tissue sarcoma being the primary tissue type; 9 of these had bony/cartilaginous in origin and only 2 of these patients had chondrosarcoma as their primary tissue type. 76% of all the patients with brain metastases also had lung metastases.

The authors reviewed the world literature in their Discussion (up to 1994), and I draw your attention to the paragraph,

“metastatic chondrosarcoma to the brain is also a rarity and only seven cases have been published to date (references 11,42-46).

There are however no demographics on how many chondrosarcomas (of all grades) actually have brain metastases.

Additional evidence that these patients do not develop brain metastases,

1) Bindal RK, Sawaya RE, Leavens ME, Taylor SH, Guinee VF.   Sarcoma metastatic to the brain: results of surgical treatment, Neurosurgery. 1994 Aug;35(2):185-90;

Reviewing 21 similar patients with brain metastases from sarcoma, had NO patients with a chondrosarcoma.

2) Salvati M, Cervoni L, Caruso R, Gagliardi FM, Delfini R.   Sarcoma metastatic to the brain: a series of 15 cases, Surg Neurol. 1998 Apr;49(4):441-4

Similarly this group reviewed 15 patients with brain metastases from sarcomas, NONE of whom had had chondrosarcoma as their primary tumour.

3) Ogose A, Morita T, Hotta T, Kobayashi H, Otsuka H, Hirata Y, Yoshida S. Brain metastases in musculoskeletal sarcomas Jpn J Clin Oncol. 1999 May;29(5):245-7

This group looked at 480 sarcoma patients between 1975 and 1997, and 20 of these had developed brain metastases. NONE of these patients had had chondrosarcomas

4) Papagelopoulos PJ,   Galanis EC, Mavrogenis AF, Savvidou OD, Bond JR, Unni KK, Sim FH. Survivorship analysis in patients with periosteal chondrosarcoma.   lin Orthop Relat Res. 2006 Jul;448:199-207

A review of 24 Grade I and Grade II chondrosarcoma patients, wiith a mean follow-up for 17 years, 5 year survival of patients with wide excisions was 93%. At last review 25 % had died of lung metastases. NO patient had developed brain metastases.