Background

Chondrosarcoma is the second most common sarcoma of bone, accounting for about 25% of primary bone tumors. Histological grading is the single most important determinant of local recurrence and metastases, where low-grade chondrosarcoma (grade 1: atypical cartilaginous lesion) is associated with 10 years survival rate 79-100%. There has been always a debate about the need for wide resection in managing low-grade chondrosarcoma, where several reports describe successful management with intra-lesional curettage and adjuvant therapy, minimizing the need for complex reconstructive procedures and improving the expected outcomes.

Hypothesis

Grade 1 chondrosarcoma of the appendicular skeleton can be successfully treated through extended curettage and liquid nitrogen with favorable oncological and functional outcomes.

Patients and methods

We retrospectively assessed 113 patients with low grade chondrosarcoma in the appendicular skeleton, who were treated by extended curettage, adjuvant therapy using liquid nitrogen, reconstruction using polymethyl methacrylate and prophylactic fixation. Patients were assessed regarding incidence of recurrence, incidence of non-oncological complications and functional outcome.

Results

The mean follow up period was 110 months. In three patients (2.7%), local recurrence occurred. Five point three percent of the patients got non-oncological complications that were successfully managed. The mean MSTS score was 95%, with no evidence of distant metastases or disease related mortality.

Conclusion

Grade 1 chondrosarcoma in the appendicular skeleton can be effectively treated using extended curettage, liquid nitrogen as adjuvant and cement as filler. Prophylactic fixation is required to avoid pathological fractures. When done properly, excellent functional outcome is expected.

Level of evidence

IV, Case series (retrospective comparative study).

中文翻译：

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扩刮液氮治疗低度恶性阑尾骨软骨肉瘤患者的远期随访

背景

软骨肉瘤是第二常见的骨肉瘤，约占原发性骨肿瘤的25%。组织学分级是局部复发和转移的最重要决定因素，其中低级别软骨肉瘤（1 级：非典型软骨病变）与 10 年生存率 79-100% 相关。关于在治疗低级别软骨肉瘤时是否需要广泛切除一直存在争论，其中一些报告描述了通过病灶内刮除术和辅助治疗成功治疗，最大限度地减少了复杂重建手术的需要并改善了预期结果。

假设

阑尾骨骼的 1 级软骨肉瘤可以通过扩大刮除术和液氮成功治疗，具有良好的肿瘤学和功能结果。

患者和方法

我们回顾性评估了 113 例阑尾骨骼低级别软骨肉瘤患者，这些患者采用扩大刮除术、液氮辅助治疗、聚甲基丙烯酸甲酯重建和预防性固定治疗。对患者的复发率、非肿瘤并发症的发生率和功能结果进行了评估。

结果

平均随访期为 110 个月。三名患者 (2.7%) 发生局部复发。五点三的患者出现非肿瘤并发症并得到成功控制。平均 MSTS 评分为 95%，没有远处转移或疾病相关死亡率的证据。

结论

附肢骨骼1级软骨肉瘤采用扩大刮除术、液氮为辅助、骨水泥为填充剂可有效治疗。需要预防性固定以避免病理性骨折。如果操作得当，可望获得出色的功能性结果。

证据等级

四、病例系列（回顾性比较研究）。