Chondrosarcoma of the pelvis - A review of sixty-four cases

Background: Treatment of pelvic chondrosarcoma is a difficult problem for t he musculoskeletal oncologist. Poor rates of survival and high rates of loc al recurrence after surgical treatment have been reported in previous studi es. The present study was designed to review the long-term oncologic and fu nctional outcomes of surgical management in a large series of patients with pelvic chondrosarcoma who were treated at a single institution. Methods: The cases of sixty-four patients with localized pelvic chondrosarc oma that had been surgically treated between 1975 and 1996 were reviewed re trospectively. The study was limited to patients who had received no previo us treatment for chondrosarcoma. There were forty-one male and twenty-three female patients who had a mean age of forty-seven years (range, fifteen to eighty-eight years). The patients were followed for a minimum of three yea rs or until death. The median duration of follow-up of the living patients was 140 months (range, thirty-nine to 295 months). Results: Thirty-three of the sixty-four patients were first seen with grade -1 chondrosarcoma; twenty-three, with grade-2; one, with grade-3; and seven , with grade-4 (dedifferentiated chondrosarcoma). Thirteen patients had a h emipelvectomy to achieve local tumor control, whereas fifty-one patients un derwent a limb-salvage procedure. Twelve patients (19%) had local recurrenc e, and eleven (17%) had distant metastases. At the time of the final follow -up, forty-four patients (69%) were alive without evidence of disease, thir teen (20%) had died of the disease, six (9%) had died of unrelated causes, and one (2%) was alive with disease. Less than a wide surgical margin corre lated with local recurrence (p = 0.014). High-grade tumors correlated with poor overall survival (p < 0.001). All patients who had a limb-salvage proc edure were able to walk at the time of the final follow-up, and they had a mean functional score of 77%, according to the system of the Musculoskeleta l Tumor Society. Conclusions: Aggressive surgical resection of pelvic chondrosarcoma results in long-term survival of the majority of patients. There is a high correla tion between tumor grade and overall or disease-free survival.