CORR® Tumor Board: Is the Width of a Surgical Margin Associated with the Outcome of Disease in Patients with Peripheral Chondrosarcoma of the Pelvis? A Multicenter Study.

Abstract

What are the surgical and research implications of this study? Megan E. Anderson MD Orthopaedic Oncology Surgeon Beth Israel Deaconess Medical Center and Boston Children’s Hospital In our last CORR Tumor Board column [2], we detailed the ways that advanced surgical and imaging technology integrate in the presurgical planning of pelvic and sacral sarcoma resections, how computer navigation systems can help surgeons achieve negative margins as they perform those resections, and how those margins ultimately are assessed by pathologists. The article by Tsuda and colleagues [10], makes the next logical step: Tying the quality of the margin to local and distant relapse and thus overall survival. That study reports on a specific type of chondrosarcoma, peripheral pelvic chondrosarcomas, or what some also refer to as pelvic surface chondrosarcomas. These are uncommon tumors, about which there is limited evidence [5, 7], necessitating multicenter collaboration like that in the study by Tsuda’s team [10]. They found that achieving a completely negative margin improves local control for these tumors, and pelvic chondrosarcomas can behave more aggressively clinically than their grade would suggest. Local relapse for a pelvic sarcoma can portend death in some cases, not frommetastasis to vital organs, but from the pressure of large recurrences on neighboring vital organs, which diminishes overall survival. These tumors are easy to underestimate because they appear as a somewhat dysplastic osteochondroma, but with a large cartilage cap. And while it seems straightforward simply to remove the surface of the involved bone and achieve a negative margin, these tumors often extend under the