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Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt

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Presentation on theme: "Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt"— Presentation transcript:

1 Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt
Chondrosarcoma of Bone: Survival Analysis and Prognostic Factors in a Series of 155 Patients Treated at a Single Institution 15th Annual CTOS Meeting, Miami Beach, FL Per-Ulf Tunn, D. Andreou, S. Fehlberg, M. Werner, P. Reichardt Department of Orthopedic Oncology Chair: P.-U. Tunn, MD Sarcoma Center Berlin-Brandenburg HELIOS Klinikum Berlin-Buch, Germany

2 Chondrosarcoma of bone
resistant to standard CT or RT cornerstone of treatment:  adequate surgery novel therapeutic approaches: tyrosine kinase inhibitors bisphosphonates proton beam radiotherapy Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

3 Patients and Methods study design: retrospective analysis
number of patients: 155 (94 men, 61 women) time period: mean age: 47.8 years (range, 12 – 79) mean follow-up: 79.9 months (range, 6 – 337) Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

4 Patients and Methods tumor localization: lower extremity n = 62
pelvic girdle n = 54 upper extremity n = 29 axial skeleton n = 10 mean tumor volume: cm3 (range, 0.2 to 8424) pathological fracture: lower extremity n = 8 upper extremity n = 5 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

5 Patients and Methods grading: G1 n = 75 G2 n = 56 G3 n = 24
surgical treatment: limb-sparing n = 100 ablative n = 45 surgical margins: wide n = 121 marginal n = 8 intralesional n = 26 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

6 Results Overall survival Event-free survival Time in months
Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

7 Results – tumor localization
Overall survival Event-free survival extremities (CE) CE axial skeleton and pelvis (CAP) CAP Time in months Time in months p = 0.075 p = 0.114 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

8 Results – age and gender
Overall survival Overall survival age ≤ 40 women age > 40 men Time in months Time in months p < 0.001 p = 0.295 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

9 Results – local recurrence
Overall survival Overall survival CE – no local recurrence CAP – no local recurrence CE – local recurrence CAP – local recurrence Time in months Time in months p < 0.001 p = 0.017 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

10 Overall survival following
Results – metastasis Overall survival following metastatic disease Overall survival no metastasis further treatment best supportive care metastasis Time in months Time in months p < 0.001 p = 0.002 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

11 Results – tumor grading
Overall survival Event-free survival G1 G1 G2 G2 G3 G3 Time in months Time in months p < 0.001 p < 0.001 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

12 Results – tumor grading
Overall survival – CAP Overall survival – CE G1 G1 G2 G2 G3 G3 Time in months Time in months p = 0.107 G1 vs. G3: p = 0.034 p < 0.001 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

13 Results – pathological fracture
lower extremity Overall survival p < 0.001 no pathological fracture upper extremity pathological fracture Time in months p = 0.747 p = 0.028 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

14 Results – surgical margins
CAP group Overall survival marginal intralesional p = 0.530 p < 0.001 CE group wide Time in months p = 0.409 p = 0.747 p = 0.422 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

15 Results – surgical margins
CAP group Event-free survival p = 0.036 wide CE group marginal intralesional Time in months p = 0.109 wide vs. intralesional: p = 0.019 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

16 Results – tumor stage Overall survival Event-free survival p = 0.001
IA IB IA IIA IIA IB IIB IIB Time in months Time in months p = 0.001 p = 0.012 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

17 Results – tumor stage Overall survival – CE group
Overall survival – CAP group IIA IA IB IA IB IIB IIB IIA Time in months Time in months p < 0.001 p = 0.166 Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

18 Conclusions – negative prognostic factors
age over 40 local recurrence systemic metastasis high grade pathological fracture at diagnosis (lower extremity) Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

19 Conclusions – quality of surgical margins
 intralesional resections of otherwise inoperable tumors could be justified no influence on overall survival decreased event-free survival for intralesional resections only in patients with tumors of the axial skeleton or pelvis Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

20 Conclusions – AJCC staging system
no correlation with oncological outcome in patients with tumors of the axial skeleton or pelvis if these results are confirmed in other studies, the development of a separate staging system for these tumors might be warranted Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany Dimosthenis Andreou

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