Outcomes and Management of Positive Margins in Chondrosarcoma With Soft Tissue Extension: A Case Series and Review of Literature

Abstract

Background

Chondrosarcoma accounts for 20% of all bone sarcomas and may present with soft tissue extension. The presence of an extraosseous component, along with positive surgical margins, independently have been associated with increased risk of local recurrence and decreased survival. The purpose of this investigation is to describe the treatment and outcomes of six chondrosarcoma patients who presented with chondrosarcoma with soft tissue extension along with positive surgical margins post negative en bloc resection.

Case

This was a retrospective review over a consecutive 13-year period. Data including treatment details and outcomes were included. All patients underwent attempted negative margin en bloc resection and encountered unplanned positive margins on intraoperative determination or postoperative pathology (R1). A total of six cases were identified. Average age (SD) was 61.8 years (6.11) with median (IQR) follow-up of 17.0 months (10.3–39.5). Three (50.0%) cases arose in the extremities, and 3 (50.0%) cases in the pelvis. All patients underwent attempted negative margin en bloc resection. Three (50.0%) cases recurred with median (IQR) time to recurrence of 10.0 months (9.0–31.0). At study conclusion, 5 (83.3%) were alive with median (IQR) survival of 20.5 months (11.3–41.0).

Conclusion

Despite limited sample size, our data reflected a significantly higher recurrence rate compared to either chondrosarcomas with positive margins or extraosseous extension. Our cohort represents a high-risk subgroup of chondrosarcoma patients, which may dictate increased monitoring and guide future treatment recommendations for these patients.