Treatment/Prognosis Flashcards
What type of surgical resection is typically recommended for chondrosarcoma?
WLE is typically recommended for definitive surgical Tx of chondrosarcoma. For ACT/CS1 intracompartmental chondrosarcomas, intralesional curettage f/b adj cryosurgery can be used as an alternative to WLE with acceptable outcome for extremity tumors.
When is RT recommended for chondrosarcoma? What are the typical doses?
RT is typically recommended for unresectable base of skull tumors or postop therapy to >70 Gy. For extracranial sites, preop RT up to 50.4 Gy if + SMs likely f/b final total RT doses of 70 Gy (R1) or 72–78 Gy (R2). For postop high grade/dedifferentiated/mesenchymal subtypes with close or + SMs use 60–70 Gy.
What is the recommended definitive Tx for skull base chondrosarcoma?
Max surgical resection is recommended for skull base chondrosarcoma. Because complete resection is generally not feasible due to anatomic constraints, adj RT is frequently recommended due to residual Dz.
What adj RT doses are necessary for control of skull base chondrosarcoma?
Adj RT doses >70 Gy are needed for control of skull base chondrosarcoma. (NCCN 2018) IMRT, stereotactic RT, or charged particle therapy are modalities to consider in the effort to minimize dose to normal critical structures.
When treated with surgical resection and adj RT, what control rates can be expected for skull base chondrosarcoma?
When treated with surgical resection and adj RT (to doses >65 Gy), control rates >95% can be expected for skull base chondrosarcoma; these rates are sup to those of chordoma. (Rosenberg AE et al., Am J Surg Pathol 1999)
What role does systemic therapy play for chondrosarcoma?
Chemo is not recommended for ACT/CS1 nor for clear cell chondrosarcoma. Its role is undefined for higher-grade chondrosarcomas, although there have been some reports that have advocated a role for chemo for the mesenchymal subtype.
What is a reasonable f/u schedule for low- and high-grade chondrosarcoma?
For f/u for low grade, consider clinical exam, imaging of primary site and chest as clinically indicated q6–12 mos for 2 yrs, then yearly. For high grade f/u, H&P, imaging of primary site as clinically indicated, and chest q3–6 mos for 5 yrs the yearly for min 10 yrs. Relapses beyond 5 yrs are more common for chondrosarcomas than for other sarcomas.
