Chondrosarcoma of the spine: 1954 to 1997

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Object. Primary chondrosarcoma of the spine is extremely rare. During the last 43 years only 21 patients with this disease were registered at The University of Texas M. D. Anderson Cancer Center. The purpose of this study was to examine the demographic characteristics, treatments, and outcomes of this set of patients.

Methods. Medical records for 21 patients were reviewed. Age, sex, race, clinical presentation, tumor histology, tumor location in the spinal column, treatments, surgical details, and response to treatment were recorded. Surgical procedures were categorized as either gross-total resection or subtotal excision of tumor. Neurological function was assessed using Frankel's functional classification. Time to recurrence and survival analyses were performed using the Kaplan—Meier method. The median age of patients was 51 years, with fairly equal gender representation. Eighteen patients underwent at least one surgical procedure for a total of 28 surgical procedures: seven radical resections and 21 subtotal excisions. Radiation therapy was used in conjunction with 10 of the 28 surgical procedures. The median Kaplan—Meier estimate of overall survival for the entire group was 6 years (range 6 months–17 years). Tumors recurred after 18 of the 28 procedures. Kaplan—Meier analysis revealed a statistically significant difference in the per-procedure disease-free interval after gross-total resection relative to subtotal excision (exact log rank 3.39; p = 0.04). The addition of radiation therapy prolonged the median disease-free interval from 16 to 44 months, although this was not statistically significant (exact log rank 2.63; p = 0.16).

Conclusions. Our results suggest that gross-total resection of the chondrosarcoma provides the best chance for prolonging the disease-free interval in patients. Subtotal excision should be avoided whenever possible. Addition of radiation therapy does not appear to lengthen significantly the disease-free interval in this patient population.

Article Information

Address reprint requests to: Ziya L. Gokaslan, M.D., Department of Neurosurgery, Box 64, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph showing results of Kaplan—Meier estimates of disease-free interval according to surgical method among 18 patients with primary chondrosacroma of the spine. The proportion of patients without recurrence is plotted on the ordinate against follow-up time since surgery on the abscissa. The dotted line denotes procedures classified as gross-total resections (seven patients), and the solid line denotes subtotal excisions (21 patients). GTR = gross-total resection; STE = subtotal excision.

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    Photograph of a pathological specimen demonstrating a gross-total resection of a primary thoracic chondrosarcoma. The pathological specimen shown represents the epidural and paraspinal extension of the tumor. After excision of this mass, a vertebrectomy was performed using a high-speed drill.

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    The pre-(upper left) and postoperative (upper right), T1-weighted gadolinium-enhanced magnetic resonance images corresponding to the gross specimen in Fig. 2. An intraoperative photograph (lower left) after a three-level vertebrectomy demonstrates the decompressed thecal sac. A radiograph demonstrates anterior reconstruction with methylmethacrylate and posterior fixation (lower right).

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    Graph demonstrating the Kaplan—Meier curve for the disease-free interval according to treatment with or without postoperative radiation therapy in patients with primary chondrosarcoma of the spine. The proportion without recurrence is plotted on the ordinate against follow-up time since surgery on the abscissa. The dotted line denotes the 10 procedures in patients who received radiation therapy, whereas the solid line represents the 18 procedures in patients who did not receive it.

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    Graph showing overall survival in 18 surgically treated patients with primary chondrosarcoma of the spine. Percentage of survival as estimated by the Kaplan—Meier method is plotted on the ordinate against follow-up time since diagnosis on the abscissa.

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