per-ulf tunn, d. andreou, s. fehlberg, m. werner, p. reichardt department of orthopedic oncology...
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Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt
Department of Orthopedic OncologyChair: P.-U. Tunn, MD
Sarcoma Center Berlin-BrandenburgHELIOS Klinikum Berlin-Buch, Germany
Chondrosarcoma of Bone: Survival Analysis and Prognostic Factors in a Series of 155 Patients
Treated at a Single Institution
15th Annual CTOS Meeting, Miami Beach, FL
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Chondrosarcoma of bone
• resistant to standard CT or RT
• cornerstone of treatment:
adequate surgery
• novel therapeutic approaches:
- tyrosine kinase inhibitors
- bisphosphonates
- proton beam radiotherapy
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Patients and Methods
• study design: retrospective analysis
• number of patients: 155 (94 men, 61 women)
• time period: 1975 - 2005
• mean age: 47.8 years (range, 12 – 79)
• mean follow-up: 79.9 months (range, 6 – 337)
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Patients and Methods
• tumor localization: lower extremity n = 62
pelvic girdle n = 54
upper extremity n = 29
axial skeleton n = 10
• mean tumor volume: 470.0 cm3 (range, 0.2 to 8424)
• pathological fracture: lower extremity n = 8
upper extremity n = 5
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Patients and Methods
• grading: G1 n = 75
G2 n = 56
G3 n = 24
• surgical treatment: limb-sparing n = 100
ablative n = 45
• surgical margins: wide n = 121
marginal n = 8
intralesional n = 26
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results
Overall survival
Time in months
Event-free survival
Time in months
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – tumor localization
Overall survival
Time in months
Event-free survival
Time in months
p = 0.075 p = 0.114
extremities (CE)
axial skeletonand pelvis (CAP)
CE
CAP
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – age and gender
Overall survival
Time in months
Overall survival
Time in months
p < 0.001 p = 0.295
age ≤ 40
age > 40
women
men
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – local recurrence
Overall survival
Time in months
Overall survival
Time in months
p < 0.001 p = 0.017
CAP – no local recurrence
CAP – local recurrence
CE – no local recurrence
CE – local recurrence
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – metastasis
Overall survival
Time in months
Overall survival followingmetastatic disease
Time in months
p < 0.001 p = 0.002
no metastasis
metastasis
further treatment
best supportive care
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – tumor grading
Overall survival
Time in months
Event-free survival
Time in months
p < 0.001 p < 0.001
G1
G2
G3
G1
G2
G3
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – tumor grading
Overall survival – CAP
Time in months
Overall survival – CE
Time in months
p = 0.107 p < 0.001G1 vs. G3: p = 0.034
G1
G2
G3
G1
G2
G3
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – pathological fracture
Overall survival
Time in months
p = 0.028
no pathological fracture
pathological fracture
lower extremity
upper extremity
p < 0.001
p = 0.747
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – surgical margins
Overall survival
Time in months
p = 0.422
p < 0.001
p = 0.747
marginalintralesional
wide
p = 0.530
CAP group
CE group
p = 0.409
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – surgical margins
Event-free survival
Time in months
wide vs. intralesional: p = 0.019
CE group
p = 0.109
CAP group
p = 0.036wide
marginal
intralesional
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – tumor stage
Overall survival
Time in months
Event-free survival
Time in months
p = 0.001 p = 0.012
IA
IBIIA
IIB
IA
IB
IIA
IIB
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Results – tumor stage
Overall survival – CE group
Time in months
Overall survival – CAP group
Time in months
p < 0.001 p = 0.166
IA
IB
IIA
IIB
IA IBIIA
IIB
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Conclusions – negative prognostic factors
• age over 40
• local recurrence
• systemic metastasis
• high grade
• pathological fracture at diagnosis (lower extremity)
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Conclusions – quality of surgical margins
• no influence on overall survival
• decreased event-free survival for intralesional resections
only in patients with tumors of the axial skeleton or pelvis
intralesional resections of otherwise inoperable tumors
could be justified
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Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou
Conclusions – AJCC staging system
• no correlation with oncological outcome in patients with
tumors of the axial skeleton or pelvis
• if these results are confirmed in other studies, the
development of a separate staging system for these
tumors might be warranted