Curettage or Resection? A Review on the Surgical Treatment of Low-Grade Chondrosarcomas

Castelo, Filipe; Faria, Afonso; Miranda, Hugo; Oliveira, Vânia; Cardoso, Pedro

Publication

Curettage or Resection? A Review on the Surgical Treatment of Low-Grade Chondrosarcomas

2023-05Journal article

dc.contributor.author	Castelo, Filipe
dc.contributor.author	Faria, Afonso
dc.contributor.author	Miranda, Hugo
dc.contributor.author	Oliveira, Vânia
dc.contributor.author	Cardoso, Pedro
dc.date.accessioned	2024-06-17T15:23:14Z
dc.date.available	2024-06-17T15:23:14Z
dc.date.issued	2023-05
dc.description.abstract	Introduction Low-grade chondrosarcomas (LG-CS), including atypical cartilaginous tumors (ACT), are locally aggressive lesions. The focus of the discussion sits on the differential diagnosis between benign lesions or aggressive cartilaginous tumors and on their treatment: intralesional curettage or wide resection. This study presents the results obtained in the surgical treatment of 21 cases of LG-CS. Methods This retrospective study includes 21 consecutive patients from a single center with LG-CS who underwent surgery from 2013 to 2021. Fourteen were located in the appendicular skeleton, and seven in the axial (shoulder blade, spine, or pelvis). Mortality rate, recurrence, metastatic disease, overall survival, recurrence-free survival, and metastatic disease-free survival were analyzed for each type of procedure and each disease location. Operative complications and residual tumors were also recorded in cases where resection was performed. Survival was calculated using the Kaplan-Meier method. Results Thirteen patients underwent intralesional curettage (11 appendicular and 2 axial lesions), and eight underwent wide resection (5 axial and 3 appendicular). There were six recurrences during the follow-up, 43% of the axial lesions recurred, rising to 100% in axial curetted ones. Appendicular LG-CS recurred in 21% of cases, and only 18% of curetted appendicular lesions were not eradicated. The overall survival for the entire follow-up is 90.5%, and the 5-year survival rate is 83% (12 patients have adequate follow-up). Recurrence-free and metastasis-free survival were higher in resection cases, with 75% and 87.5%, vs. curettage 69.2% and 76.9%, respectively. In 9% of cases, the preoperative biopsy was inconsistent with the pathology of the surgical specimen. Discussion LG-CS and ACT are described as having high survival and low potential for metastatic disease. For this reason, these lesions are subject to a change in treatment philosophy to reflect these characteristics. Intra-lesional curettage is advocated as a less invasive technique for eradicating atypical cartilage tumors and has fewer and less severe complications, which was in accordance with our findings. Diagnosis, however, is challenging; misgrading is frequent and should be considered. Because of this risk of under-treating higher-grade lesions, some authors still defend wide-resection as the treatment of choice. We observed a trend towards longer survival, less recurrence, and metastatic disease with wide resection. Metastatic disease was higher than expected, present in 19% of cases, and always associated with local recurrence. Conclusion LG-CS is still a diagnostic and treatment challenge; patient selection is fundamental. Overall survival is high, independent of treatment choice or lesion location. We found a higher rate of metastatic disease than described in the literature; this, coupled with a misgrading rate of 9%, reflects the difficulty of preoperative diagnosis and the risk of treating high-grade chondrosarcomas as a low-grade lesion. More studies should be carried out with larger samples to obtain statistically robust results.	pt_PT
dc.description.version	info:eu-repo/semantics/publishedVersion	pt_PT
dc.identifier.citation	Castelo F, Faria A, Miranda H, Oliveira V, Cardoso P. Curettage or Resection? A Review on the Surgical Treatment of Low-Grade Chondrosarcomas. Cureus. 2023;15(5):e39637. doi:10.7759/cureus.39637	pt_PT
dc.identifier.doi	10.7759/cureus.39637	pt_PT
dc.identifier.issn	2168-8184
dc.identifier.uri	http://hdl.handle.net/10400.16/2932
dc.language.iso	eng	pt_PT
dc.peerreviewed	yes	pt_PT
dc.publisher	Cureus, Inc.	pt_PT
dc.relation.publisherversion	https://www.cureus.com/articles/156050-curettage-or-resection-a-review-on-the-surgical-treatment-of-low-grade-chondrosarcomas#!/	pt_PT
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	pt_PT
dc.subject	atypical cartilaginous tumor	pt_PT
dc.subject	curettage	pt_PT
dc.subject	low-grade chondrosarcoma	pt_PT
dc.subject	resection	pt_PT
dc.subject	surgical treatment	pt_PT
dc.title	Curettage or Resection? A Review on the Surgical Treatment of Low-Grade Chondrosarcomas	pt_PT
dc.type	journal article
dspace.entity.type	Publication
oaire.citation.conferencePlace	United States of America	pt_PT
oaire.citation.issue	5	pt_PT
oaire.citation.startPage	e39637	pt_PT
oaire.citation.title	Cureus	pt_PT
oaire.citation.volume	15	pt_PT
person.familyName	Castelo
person.givenName	Filipe
person.identifier.orcid	0009-0009-9726-9658
rcaap.rights	openAccess	pt_PT
rcaap.type	article	pt_PT
relation.isAuthorOfPublication	ba1ba253-4ca3-4dd5-86f5-2b84f23c6c1d
relation.isAuthorOfPublication.latestForDiscovery	ba1ba253-4ca3-4dd5-86f5-2b84f23c6c1d