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Low-Grade Chondrosarcoma of Long Bones Treated with Intralesional Curettage Followed by Application of Phenol, Ethanol, and Bone-Grafting

Verdegaal, Suzan H.M. MD; Brouwers, Hugo F.G. MD; van Zwet, Erik W. MD; Hogendoorn, Pancras C.W. MD, PhD; Taminiau, Antonie H.M. MD, PhD

Journal of Bone & Joint Surgery - American Volume: 3 July 2012 - Volume 94 - Issue 13 - p 1201–1207
doi: 10.2106/JBJS.J.01498
Scientific Articles

Background: A common treatment of low-grade cartilaginous lesions of bone is intralesional curettage with local adjuvant therapy. Because of the wide variety of different diagnoses and treatments, there is still a lack of knowledge about the effectiveness of the use of phenol as local adjuvant therapy in patients with grade-I central chondrosarcoma of a long bone.

Methods: A retrospective study was done to assess the clinical and oncological outcomes after intralesional curettage, application of phenol and ethanol, and bone-grafting in eighty-five patients treated between 1994 and 2005. Inclusion criteria were histologically proven grade-I central chondrosarcoma and location of the lesion in a long bone. The average age at surgery was 47.5 years (range, 15.6 to 72.3 years). The average duration of follow-up was 6.8 years (range, 0.2 to 14.1 years). Patients were evaluated periodically with conventional radiographs and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) scans. When a lesion was suspected on the basis of the MRI, the patient underwent repeat intervention. Depending on the size of the recurrent lesion, biopsy followed by radiofrequency ablation (for lesions of <10 mm) or repeat curettage (for those of ≥10 mm) was performed.

Results: Of the eighty-five patients, eleven underwent repeat surgery because a lesion was suspected on the basis of the Gd-MRI studies during follow-up. Of these eleven, five had a histologically proven local recurrence (a recurrence rate of 5.9% [95% confidence interval, 0.9% to 10.9%]), and all were grade-I chondrosarcomas. General complications consisted of one superficial infection, and two femoral fractures within six weeks after surgery.

Conclusions: This retrospective case series without controls has limitations, but the use of phenol as an adjuvant after intralesional curettage of low-grade chondrosarcoma of a long bone was safe and effective, with a recurrence rate of <6% at a mean of 6.8 years after treatment.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Departments of Orthopedics (S.H.M.V., H.F.G.B., and A.H.M.T.), Biostatistics (E.W.v.Z.), and Pathology (P.C.W.H.), Leiden University Medical Center, J11-70, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail address for S.H.M. Verdegaal: shmverdegaal@hotmail.com

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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