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  • The primary outcome was local recurrence

    2019-05-15

    The primary outcome was local recurrence or metastasis. The secondary outcome included functional outcome based on Musculoskeletal Tumor Society (MSTS) score. Data for the study were retrieved from hospital records, maintained oncological files, surgical files, and clinical examination at the most recent outpatient clinic. These data included surgical time, blood loss, complications, incidence of local recurrence, and distant metastases. Approval for the study was obtained from the Institutional Review Broad. We analyzed the resulting data using Student t test, Fisher\'s exact test, and analysis of variance, with a significance threshold of p<0.05 using STATA software version 12.1 (STATA, College Station, Texas, USA).
    Discussion The principle of surgery for high-grade sarcoma is to obtain a wide margin including amputation and wide excision with reconstruction. However, the surgical management of low-grade chondrosarcoma has remained under debate in recent years due to its low potential Ion Channel Compound Library and local recurrence. These characteristics of low-grade chondrosarcoma provide the possibility of a more conservative approach with less soft tissue damage. Therefore, some studies are advocated using extended intralesional curettage, which was an option for benign aggressive tumors of bone, for patients with low-grade chondrosarcoma. There are several adjuvant methods for extended intralesional curettage, such as phenol application, cauterization, or cryotherapy followed by either cementation or bone grafting. Previous studies have demonstrated that these adjuvant treatments are necessary for control of local recurrence. In our patients, cauterization with phenol and alcohol was routinely launched in the curettage technique. However, liquid nitrogen was used in selected patients due to comorbid condition or location of the tumor lesion. Also, the surrounding soft tissue with warm gauze was well covered for protection when applying liquid nitrogen. Under this condition, we performed cryotherapy in two patients (28.6%), and we suggest that long bone was good indication for adjuvant cryotherapy due to its anatomy and the ease of application. We believe either wide excision or extended intralesional curettage could be used for low-grade chondrosarcoma only if the tumor lesion would be totally removed. There was one patient of recurrence treated with curettage in our study. That case had cortical breakthrough which was noted intraoperatively. Meftah et al reported that soft tissue extension was strongly associated with local recurrence after curettage and cryotherapy. In our patients, we regarded cortical breakthrough and soft tissue extension of low-grade chondrosarcoma as adverse factors for local control. Some authors reported that local treatment led to higher local recurrence rates due to an inadequate surgical margin. Some others reported that intralesional curettage wound not increase the recurrence rates. The discrepancy of the results may be related to the extent of the curettage. The overall recurrence rate of low-grade chondrosarcoma after treatment in our study was 9.1%, and the respective recurrence rate was 14.3% in the Group A. There was no recurrence in Group B, and there was no statistically significant difference (p=0.636) in the study cohort. However, some studies suggested that axial lesion of central low-grade chondrosarcoma was an adverse factor for local recurrence after curettage. In our experience, axial lesions are difficult to approach on anatomy, and the local adjuvant treatment may be difficult to achieve. We agreed that long bone was good indication for extended intralesional curettage with adjuvant local treatment. In our study, the patient and the surgeon decided on the index surgery after evaluating surgical risk and possibility of local recurrence. The patient age was significant lesser in the Group A (p=0.001). The young patients might prefer host bone restored and less soft tissue damage in order to reserve function even though sieve elements had to take the risk of local recurrence. Tumor size showed no statistically significant difference (p=0.177) between the groups. We expected that patients treated with extended curettage would have less blood loss; however, our study showed no significant difference (p=0.151). It might be easy bleeding of bone marrow which resulted in increasing blood loss during curettage. The surgical time was shorter in Group A (p=0.01). Also, Group A had a significantly short hospital stay (p=0.010). This result was encouraging and implied less soft tissue damage and more rapid recovery.