Non-Operative Ttreatment of patients with Chondrosarcoma: An analysis of patients who refused cancer-directed surgery or patients contraindicated to surgery.

Chondrosarcomas are the second most common primary bone sarcoma. Due to chondrosarcomas relative resistance to chemotherapy and radiation, surgical treatment has become the mainstay treatment option. The purpose of our study was to understand the proportion of patients in this population who undergo non-operative treatment options secondary to various reasons and analyze the difference in survival as well as patient and cancer specific characteristics between the two groups. We retrospectively reviewed the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with primary chondrosarcoma from 1973 to 2015. We evaluated the patients for both descriptive characteristics as well as cancer specific characteristics. We then performed a propensity matched analysis and other analyses to compare difference in cancer characteristics as well as survival. There were 3048 patients with chondrosarcoma of the bone during our study period of which 188(6.2%) patients did not undergo operative treatment either due to refusal of cancer directed surgery or contraindicated to surgery. A one unit increase in age was significantly associated with increased odds of not undergoing surgery(Odds Ratio 1.04;95% CI, 1.03- 1.05). No statistically significant difference(P = 0.9) in survival was noted between patients with long bone, grade 1 chondrosarcomas regardless of if they did or did not undergo operative treatment. This study provides data to inform the patient on their decisions for or against surgery and may assist the surgeons in counseling patients regarding the surgical treatment of chondrosarcomas. Patients not undergoing operative treatment for chondrosarcomas are at statistically significantly increased risk of mortality.