Treatment of low-grade chondrosarcoma

Cartilage tumors of bone exhibit wide clinical, radiographic, and histologic variability. Patient prognosis is related to histologic grade and adequacy of surgical treatment. Although differentiation between high and low-grade cartilage tumors can be made easily on the basis of histologic findings and radiographic characteristics, the distinction between low-grade chondrosarcoma and enchondroma can be less clear in some cases. Treatment recommendations vary from intralesional excision to wide excision. In general, symptomatic intramedullary primary cartilaginous tumors of bone that are radiographically latent (enchondromas) or active, but nonaggressive (enchondroma or low-grade chondrosarcoma) can be treated effectively in the majority of patients with an intralesional excision by curettage with or without a surgical adjuvant therapy (eg, intracavitary liquid nitrogen or phenol). Wide excision is most appropriate for symptomatic cartilaginous tumors that radiographically demonstrate aggressive behavior regardless of their histologic grade. Secondary low-grade chondrosarcomas of the extremities (those arising from a preexistent benign tumor) and pelvic chondrosarcomas of all histologic grades are treated most appropriately with wide excision to minimize the risk of local recurrence and optimize patient outcome.