Is intralesional resection suitable for central grade 1 chondrosarcoma: a systematic review and updated meta-analysis

• Published in: European journal of surgical oncology Vol. 43; no. 9; pp. 1718 - 1726
• Main Authors: Chen, Xi, M.D, Yu, Lingjia, Ph.D, Peng, Huiming, Ph.D, Chao, Jiang, M.D, Ye, Canhua, M.D, Zhu, Shibai, M.D, Qian, Wenwei, Ph.D
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2017
• Subjects: Bone Neoplasms - pathology; Bone Neoplasms - surgery; Chondrosarcoma - pathology; Chondrosarcoma - surgery; Complications; Grade 1 chondrosarcoma; Hematology, Oncology and Palliative Medicine; Humans; Intralesional curettage; Local recurrence; Margins of Excision; Musculoskeletal System - physiopathology; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Recurrence, Local; Postoperative Complications - etiology; Surgery; grade 1 chondrosarcoma; local recurrence; complications; intralesional curettage; Surgery; Intralesional curettage; Grade 1 chondrosarcoma; Complications; Local recurrence
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2017.05.022

Abstract Background The surgical choice for grade 1 chondrosarcoma has been debated for decades. Intralesional resection can minimize the damage caused by surgery and offer better functional outcome. However, controversy remains about whether it will result in higher rates of local recurrence and metastasis, fewer complications, and better functional outcome compared with resection with wide margin. This systematic review and updated meta-analysis therefore compared intralesional resection and resection with wide margin in terms of local recurrence, metastasis, complications, and functional outcome. Methods Medline, Embase, and the Cochrane Library were comprehensively searched in December 2016 to identify studies comparing intralesional resection and resection with wide margin for central grade 1 chondrosarcoma. Data of interest were extracted and analyzed using Review Manager 5.3. Results Ten studies involving 394 patients were included, with 214 patients who had intralesional resection and 180 patients who had resection with wide margin for grade 1 chondrosarcoma. Intralesional resection was associated with lower complication rates (P<0.0001) and better Musculoskeletal Tumor Society score (MSTS). There were no significant differences in terms of overall local recurrence (P=0.27), local recurrence based on adjuvant therapies (P=0.22), local recurrence in studies that included lesions of the hand, foot, pelvis, and axial skeleton (P=0.55), and metastasis (P=0.74) between groups. Conclusion Intralesional resection provides lower complications and better functional outcome with no significant increase in the risk of recurrence and metastasis. We think it is a suitable treatment for central grade 1 chondrosarcoma.