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

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.

Outcome of advanced/inoperable central chondrosarcomas.

Aim of the studyAim of the study

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.

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.

Definition of advanced/inoperable central chondrosarcoma

Definition of advanced/inoperable central chondrosarcoma

A tumor that, at first presentation, or after treatment, surgically cannot be rendered totally disease free, for local extension or

metastatic lesions

A tumor that, at first presentation, or after treatment, surgically cannot be rendered totally disease free, for local extension or

metastatic lesions

PatientsPatients

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

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

Stage in inoperable patientsStage in inoperable patients

Local disease only 45

(26%)

Lung only 72

(42%)

Local + lung 39

(23%)

Disseminated disease 15 (9%)

Local disease only 45

(26%)

Lung only 72

(42%)

Local + lung 39

(23%)

Disseminated disease 15 (9%)

SurvivalSurvival

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

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

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120months

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120months

Cum

. Sur

viva

l

months

Cum

. Sur

viva

l

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120

months

Cum

. Sur

viva

l

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120

Non Significant VariablesNon Significant Variables

OS and GenderOS and Gender

OS and Site(Axial or Extremity) OS and Site(Axial or Extremity)

OS and Operable vs Inoperable at Diagnosis

OS and Operable vs Inoperable at Diagnosis

Cum. Survival (M)Cum. Survival (F)

Cum. Survival (E)Cum. Survival (A)

Unresect after first treat

Unres at first diagnosis

P-Value 0.1330P-Value 0.1330

P-Value 0.5849P-Value 0.5849

P-Value 0.4115P-Value 0.4115

Histological Grade at first diagnosis/after progression

Histological Grade at first diagnosis/after progression

GradeInoperable, at diagnosis

Treated, at 1st diagnosis

Final

1 2 (4%) 7 (5%) 4 (2%)

2 34 (69%) 80 (66%) 93 (54%)

3 13 (27%) 35 (29%) 66 (39%)

Dediff 0 0 8 (5%)

OS and Grade at 1st diagnosis OS and Grade at 1st diagnosis

OS and Grade after progressionOS and Grade after progression

0

,2

,4

,6

,8

1

Cum

. S

urv

ival

0 12 24 36 48 60 72 84 96 108 120months

Grade 3 Grade 2

Grade 1

P-Value 0.0187P-Value 0.0187

0

,2

,4

,6

,8

1

0 20 40 60 80 100 120Time

Dediff

32

1

Cum

. S

urv

ival

P-Value 0.0043P-Value 0.0043 P-Value 0.0039P-Value 0.0039

0

,2

,4

,6

,8

1

0 20 40 60 80 100 120Time

Three Dediff One Two

Cum

. S

urv

ival

Survival by Stage of DiseaseSurvival by Stage of Disease

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

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

0

,2

,4

,6

,8

1

Cum

. S

urvi

val

0 12 24 36 48 60 72 84 96 108 120months

OS and stage of inoperable diseaseOS and stage of inoperable disease

P-Value 0.0049P-Value 0.0049

multiple sites

lung only

local + lung

local only

Role of non surgical treatmentsRole 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.

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.

OS and Medical Treatment (all pts) OS and Medical Treatment (all pts)

P-Value 0.0487P-Value 0.0487

Pts with metastasis only (local & local + met excluded)Pts with metastasis only (local & local + met excluded)

P-Value 0.0082P-Value 0.0082

0

,2

,4

,6

,8

1

0 12 24 36 48 60months

Cum

. S

urvi

val

Cum. Survival (YES)

Cum. Survival (NO)

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120months

Cum. Survival (YES)

Cum. Survival (NO)

Cum

. S

urvi

val

Role of non surgical treatmentsRole 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.

Radiotherapy was given in 36 pts and survival was 27% at 36

months vs 8% for those who did not receive it.

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120months

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120

months

0

,2

,4

,6

,8

1

0 12 24 36 48 60 72 84 96 108 120months

OS and Radiotherapy (all pts) OS and Radiotherapy (all pts)

P-Value0.1052P-Value0.1052

OS and Radiotherapy (Local only)OS and Radiotherapy (Local only)P-Value 0.0032P-Value 0.0032

OS and Radiotherapy (Local + met)OS and Radiotherapy (Local + met)

P-Value0.1063P-Value0.1063

Cum. Survival (YES)Cum. Survival (NO)

Cum. Survival (YES)

Cum. Survival (NO)

Cum. Survival (YES)

Cum. Survival (NO)

Cum

. Sur

viva

l

ConclusionsConclusions

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 ?)

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 ?)