Grade 2 central chondrosarcoma treated by intralesional curettage: observation or surgery? : a multicentre retrospective study.
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AIMS: The most appropriate management of patients who have undergone curettage for a suspected low-grade chondrosarcoma (CS), which has subsequently been found to be of grade 2, remains unknown. We aimed to assess whether these patients have an increased risk of local recurrence and distant metastasis if followed up over time, compared to those who undergo further treatment soon after the diagnosis has been established. METHODS: A retrospective study was undertaken which included 71 patients treated between January 2010 and December 2022 by intralesional curettage for a supposed low-grade CS, but who subsequently proved to have a histological grade 2 CS. Thereafter, patients either underwent further surgery (resection group) or follow-up (follow-up group). RESULTS: The estimated local recurrence rate was 36.8% at five (95% CI 35.6 to 38.0) and 48.1% at ten years (95% CI 46.4 to 49.8), and was significantly higher in the follow-up group (48.4%, 95% CI 45.4 to 51.4) than in the resection group (9.6%, 95% CI 8.1 to 11.1) at five years (p = 0.005). Locally recurrent CS, considered as a time-dependent covariate, had an increased risk of metastasis (36.8% vs 2.5% at five years; p < 0.001) and a worse disease-specific survival (81.3% vs 100% at five years; p = 0.007). CONCLUSION: The optimal treatment strategy should be individualized based on the histological features of the tumour, tumour location, morbidity of resection, and patient-specific factors. We recommend that patients who have undergone unplanned surgery be treated in the standard manner. Observation may be appropriate in specific cases with a properly informed patient.