Evaluation of different treatment and management options for chondrosarcoma; the prognostic factors determining the outcome of the disease

Abstract

Importance: This review provides an in-depth discussion of the different treatment and management strategies adopted for chondrosarcoma, the various outcomes and the prognostic factors of the disease. Chondrosarcoma is the third most common malignant bone tumor after myeloma and osteosarcoma. It is characterized by the production of a cartilaginous matrix by malignant cells. It can be classified according to the source of its origin, histopathologic grade, site of occurrence, and rarity. Chondrosarcomas that are de novo in nature are classified as primary chondrosarcomas, while those derived from pre-existing enchondromas or osteochondromas are regarded as secondary chondrosarcomas. Other rare forms of chondrosarcoma include dedifferentiated, mesenchymal, and clear cell chondrosarcomas. Observations/Findings: Early diagnosis, accurate interpretation of histopathology, precise grading, and careful localization are crucial in the management of chondrosarcoma. Surgery is the treatment of choice. Three forms of surgical interventions are present; curettage, radical resection, and amputation. The choice of procedure depends on the size and site of the lesion and degree of malignancy. Radical procedures give the most promising outcomes with wider margins yielding better prognosis. Recurrence is usually seen with delayed surgery, high histopathologic grading, inadequate surgical procedures, marginal excision or curettage, tumor present in inaccessible sites such as sacrum and metastasis. Conclusion: Chondrosarcoma is responsible for placing a significant burden on pediatric as well as adult orthopedic oncology. Optimum diagnosis, accurate interpretation of histopathology, precise grading, careful localization, and timely as well as adequate management is crucial to successfully manage and prevent recurrence of the disease. Surgery is the most effective form of treatment. The main goal of treatment and management is to keep well ahead of the growth of the neoplasm and to prevent recurrences.