Outcomes and Management of Positive Margins in Chondrosarcoma with Soft
Tissue Extension: A Case Series and Review of Literature
Abstract
Background Chondrosarcoma accounts for 20% of all bone sarcomas
and may present with soft tissue extension. The presence of an
extraosseous component, along with positive surgical margins, have been
separately associated with increased risk of local recurrence and
decreased survival. The purpose of this investigation is to describe the
treatment and outcomes of 7 chondrosarcoma patients who presented with
both chondrosarcoma with soft tissue extension as well as positive
surgical margins post wide en bloc resection. Methods This was a
retrospective review over a consecutive thirteen-year period. Data
including treatment details and outcomes were included. All patients
underwent attempted negative margin wide en bloc resection and
encountered unplanned positive margins on intraoperative determination
or post-operative pathology. Results A total of 7 cases were
identified. Average age (SD) was 61.1 years (5.87) with median (range)
follow-up of 17.0 months (3, 91). Four (57.1%) cases arose in the
extremities, and 3 (42.9%) cases in the pelvis. All patients underwent
attempted negative margin wide en bloc resection. Four (57.1%) cases
recurred with median (IQR) time to recurrence 16.0 months (9.50, 22.0).
At study conclusion, five (71.4%) were alive with median (IQR) survival
of 23 months (12.5, 36). Overall survival (OS) probability was 100%,
53.3%, and 53.3% at 1, 3, and 5-years, respectively. Recurrence-free
survival (RFS) was 60%, 40%, and 40% at 1-, 3-, and 5-years,
respectively. Conclusion Despite a limited sample size, our data
reflected similar OS to chondrosarcomas with positive margins alone, but
a higher recurrence rate. Our cohort represents a high-risk subgroup of
chondrosarcoma patients, which may dictate increased monitoring and
guide future treatment recommendations for these patients.