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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. 15 th 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

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

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  1. 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

  3. Patients and Methods • study design: retrospective analysis • number of patients: 155 (94 men, 61 women) • time period: 1975 - 2005 • 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

  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: 470.0 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

  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

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

  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

  8. Results – age and gender Overall survival Overall survival age ≤ 40 women men age > 40 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

  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

  10. 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

  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

  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

  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

  14. Results – surgical margins CAP group Overall survival marginal intralesional p < 0.001 p = 0.530 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

  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

  16. Results – tumor stage Overall survival Event-free survival 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

  17. Results – tumor stage Overall survival – CE group Overall survival – CAP group IA IIA 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

  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

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

  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

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