Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt Department of Orthopedic Oncology...

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

Department of Orthopedic OncologyChair: P.-U. Tunn, MD

Sarcoma Center Berlin-BrandenburgHELIOS Klinikum Berlin-Buch, Germany

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

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

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 Dimosthenis Andreou

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 Dimosthenis Andreou

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 Dimosthenis Andreou

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 Dimosthenis Andreou

Results

Overall survival

Time in months

Event-free survival

Time in months

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

Results – tumor localization

Overall survival

Time in months

Event-free survival

Time in months

p = 0.075 p = 0.114

extremities (CE)

axial skeletonand pelvis (CAP)

CE

CAP

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

Results – age and gender

Overall survival

Time in months

Overall survival

Time in months

p < 0.001 p = 0.295

age ≤ 40

age > 40

women

men

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

Results – local recurrence

Overall survival

Time in months

Overall survival

Time in months

p < 0.001 p = 0.017

CAP – no local recurrence

CAP – local recurrence

CE – no local recurrence

CE – local recurrence

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

Results – metastasis

Overall survival

Time in months

Overall survival followingmetastatic disease

Time in months

p < 0.001 p = 0.002

no metastasis

metastasis

further treatment

best supportive care

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

Results – tumor grading

Overall survival

Time in months

Event-free survival

Time in months

p < 0.001 p < 0.001

G1

G2

G3

G1

G2

G3

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

Results – tumor grading

Overall survival – CAP

Time in months

Overall survival – CE

Time in months

p = 0.107 p < 0.001G1 vs. G3: p = 0.034

G1

G2

G3

G1

G2

G3

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

Results – pathological fracture

Overall survival

Time in months

p = 0.028

no pathological fracture

pathological fracture

lower extremity

upper extremity

p < 0.001

p = 0.747

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

Results – surgical margins

Overall survival

Time in months

p = 0.422

p < 0.001

p = 0.747

marginalintralesional

wide

p = 0.530

CAP group

CE group

p = 0.409

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

Results – surgical margins

Event-free survival

Time in months

wide vs. intralesional: p = 0.019

CE group

p = 0.109

CAP group

p = 0.036wide

marginal

intralesional

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

Results – tumor stage

Overall survival

Time in months

Event-free survival

Time in months

p = 0.001 p = 0.012

IA

IBIIA

IIB

IA

IB

IIA

IIB

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

Results – tumor stage

Overall survival – CE group

Time in months

Overall survival – CAP group

Time in months

p < 0.001 p = 0.166

IA

IB

IIA

IIB

IA IBIIA

IIB

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

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 Dimosthenis Andreou

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 Dimosthenis Andreou

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