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Is Skeletal Imaging Essential in the Staging Workup for Conventional Chondrosarcoma? | LitMetric

Is Skeletal Imaging Essential in the Staging Workup for Conventional Chondrosarcoma?

Clin Orthop Relat Res

A. Gulia, V. Kurisunkal, A. Puri, N. Purandare, S. Gupta, V. Rangarajan, Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India.

Published: November 2020

AI Article Synopsis

  • Staging chondrosarcoma is important for determining treatment and prognosis, but current guidelines don't provide specific recommendations for this type of cancer despite its rare skeletal metastases.
  • A study of 427 patients with histologically confirmed chondrosarcoma revealed that 8% had isolated lung metastases at diagnosis, with a higher prevalence in Grade 2 and Grade 3 cases compared to Grade 1.
  • The research highlights the need for thorough staging practices in chondrosarcoma cases, as many patients present with significant metastasis that can influence treatment approaches.

Article Abstract

Background: Staging of a bone sarcoma before initiating treatment helps orthopaedic oncologists determine the intent of treatment and predicting the prognosis. As per National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines, there are no exclusive recommendations for chondrosarcoma staging. They are staged similar to other bone sarcomas even though skeletal metastases are extremely rare in chondrosarcomas.

Questions/purposes: We asked: (1) What proportion of patients with a chondrosarcoma present with detectable only skeletal metastasis? (2) What proportion of patients with chondrosarcoma present with skeletal metastasis with or without concurrent pulmonary metastases?

Methods: Between January 2006 to December 2017, 480 patients with histology-proven chondrosarcomas of the extremity, including clavicle, scapula, spine, and pelvis, presented to our institute. Fifty-three patients were excluded due to incomplete details about their staging. The remaining 427 were retrospectively analyzed and included in this study. Their clinical, radiological, and histopathological details were retrieved from patient files and electronic medical records. Of the 427 patients included, 53 had Grade 1 chondrosarcoma, 330 had Grade 2 chondrosarcoma, and 41 had Grade 3 chondrosarcoma. Grade was not available in three patients. All patients were staged with a thoracic CT scan and bone scan or a whole body fluorodeoxyglucose positron-emission tomography/CT (FDG PET/CT). Patients with a suspected or documented metastasis were reviewed again by an experienced radiologist and a nuclear medicine expert for the purpose of this study. A total of 8% (35 of 427) of patients with chondrosarcoma had isolated lung metastases at the time of initial staging. These included 9% (31 of 330) of patients with Grade 2 chondrosarcomas and 10% (4 of 41) of patients with Grade 3 chondrosarcomas. No patient with a Grade 1 chondrosarcoma had detectable lung metastases. The primary study endpoint was the number of patients who had a diagnosis of skeletal or skeletal and lung metastases as identified by the staging modalities.

Results: Three patients with Grade 2 chondrosarcoma had only skeletal metastasis. No patients with Grade 1 or Grade 3 chondrosarcoma had detectable bone metastases. Combined lung and bone metastases were seen in only two patients with Grade 2 chondrosarcoma.

Conclusions: Our study found that the incidence of bony metastasis in conventional chondrosarcomas is extremely low. Considering the present results, we believe skeletal scanning may be overused in current staging algorithms. We do not have survival outcomes to know if detecting these few patients with skeletal lesions at initial presentation would be important in the absence of symptoms, but our data suggest that omitting skeletal imaging from the staging work-up of conventional chondrosarcomas should be considered. It may be reserved for patients with documented pulmonary metastases.

Level Of Evidence: Level IV, diagnostic study.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594919PMC
http://dx.doi.org/10.1097/CORR.0000000000001357DOI Listing

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