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P. Picci, A. van Maldegem, E. Palmerini, P.D.S. Dijkstra, M. Alberghini, J.V.M.G. Bovee,

P. Picci, A. van Maldegem, E. Palmerini, P.D.S. Dijkstra, M. Alberghini, J.V.M.G. Bovee, P. Ruggieri, C. Ferrari, S. Ferrari, H. Gelderblom. Istituto Ortopedico Rizzoli, Bologna, Italy and Leiden University Medical Center, The Netherlands.

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P. Picci, A. van Maldegem, E. Palmerini, P.D.S. Dijkstra, M. Alberghini, J.V.M.G. Bovee,

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  1. P. Picci, A. van Maldegem, E. Palmerini, P.D.S. Dijkstra, M. Alberghini, J.V.M.G. Bovee, P. Ruggieri, C. Ferrari, S. Ferrari, H. Gelderblom. Istituto Ortopedico Rizzoli, Bologna, Italy and Leiden University Medical Center, The Netherlands Outcome of advanced/inoperable central chondrosarcomas.

  2. Little is known about the survival of central chondrosarcomas when surgical removal of local or metastatic disease is considered unfeasible. Particularly no information is available on survival in this condition. Aim of the study

  3. A tumor that, at first presentation, or after treatment, surgically cannot be rendered totally disease free, for local extension or metastatic lesions Definition of advanced/inoperable central chondrosarcoma

  4. Patients Data from 2 major European Centers: Rizzoli Orthopedic Institute (IOR) Leiden University Medical Center (LUMC) 171 inoperable pts (IOR 126, LUMC 45) 49 cases at first diagnosis. 122 cases after one or more relapses. Inoperable after 23.5 mos (1-233) from 1st diagnosis

  5. Local disease only 45 (26%) Lung only 72 (42%) Local + lung 39 (23%) Disseminated disease 15 (9%) Stage in inoperable patients

  6. Overall survival for all 171 pts was: 48% at 1 year 24% at 2 years 12% at 3 years 6% at 4 years 2% at 5 years Median time to death was 11 months with a range of 1-106 months 1 ,8 ,6 ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months Survival

  7. 1 ,8 ,6 Cum. Survival ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months 1 ,8 ,6 Cum. Survival ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months 1 ,8 ,6 Cum. Survival ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months Non Significant Variables OS and Gender P-Value 0.1330 Cum. Survival (F) Cum. Survival (M) OS and Site (Axial or Extremity) P-Value 0.5849 Cum. Survival (A) Cum. Survival (E) OS and Operable vs Inoperable at Diagnosis P-Value 0.4115 Unres at first diagnosis Unresect after first treat

  8. Histological Grade at first diagnosis/after progression

  9. OS and Grade at 1st diagnosis P-Value 0.0187 1 ,8 ,6 Cum. Survival ,4 ,2 Grade 1 0 Grade 3 Grade 2 0 12 24 36 48 60 72 84 96 108 120 months OS and Grade after progression P-Value 0.0043 P-Value 0.0039 1 1 ,8 ,8 ,6 ,6 Cum. Survival Cum. Survival ,4 ,4 1 ,2 ,2 Dediff One Two 2 Three Dediff 0 3 0 0 20 40 60 80 100 120 0 20 40 60 80 100 120 Time Time

  10. Local disease only: 26% at 36 mos (median 18, range 1-104) Lung only: 7% at 36 mos (median 11, range 1-51) Local + lung: 8% at 36 mos (median 9, range 1-106) Disseminated: 0% at 24 mos (median 7, range 2-24) p = 0.0014 Survival by Stage of Disease

  11. OS and stage of inoperable disease 1 local only local + lung ,8 lung only multiple sites ,6 Cum. Survival ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months P-Value 0.0049

  12. Role of non surgical treatments 37 pts received systemic antitumour treatment, with a survival of 26% at 36 months, compared to 8% for those pts who did not receive it.

  13. 1 ,8 ,6 Cum. Survival ,4 ,2 Cum. Survival (YES) Cum. Survival (NO) 0 0 12 24 36 48 60 72 84 96 108 120 months 1 ,8 ,6 Cum. Survival ,4 Cum. Survival (YES) ,2 Cum. Survival (NO) 0 0 12 24 36 48 60 months OS and Medical Treatment (all pts) P-Value 0.0487 Pts with metastasis only (local & local + met excluded) P-Value 0.0082

  14. Role of non surgical treatments Radiotherapy was given in 36 pts and survival was 27% at 36 months vs 8% for those who did not receive it.

  15. 1 ,8 ,6 ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months 1 ,8 ,6 ,4 ,2 0 0 12 24 36 48 60 72 84 96 108 120 months OS and Radiotherapy (all pts) OS and Radiotherapy (Local + met) P-Value 0.1052 P-Value 0.1063 Cum. Survival (YES) Cum. Survival (YES) Cum. Survival (NO) Cum. Survival (NO) OS and Radiotherapy (Local only) P-Value 0.0032 1 ,8 ,6 Cum. Survival ,4 ,2 Cum. Survival (YES) Cum. Survival (NO) 0 0 12 24 36 48 60 72 84 96 108 120 months

  16. This pooled analysis of the largest series of inoperable chondrosarcoma pts allowed us to gain insight on prognosis of these pts who can serve as benchmark for future studies. These data indicate the need for further investigation on the role of systemic treatment (in metastatic pts ?) and radiotherapy (in locally advanced pts ?) Conclusions

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