Dr Randall on the Evolving Role of Surgical Management in Low-Grade Chondrosarcoma

"A less aggressive resection can afford a much better quality of life over the years, and, in my opinion, can provide adequate local control."

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopaedic Surgery, as well as a professor and chair of the Department of Orthopaedic Surgery at the University of California, Davis Comprehensive Cancer Center, discussed the evolving role of surgical management in patients with low-grade chondrosarcoma, emphasizing the appropriateness of conservative intralesional approaches in select cases.

Low-grade chondrosarcomas—typically defined by lesions confined within the bone and lacking aggressive radiographic features—have historically presented a management dilemma regarding the extent of surgical resection, Randall began. According to Dr Randall, accumulating evidence supports the use of conservative surgery, specifically intralesional curettage with adjuvant measures (e.g., local adjuvant therapy and structural reinforcement), as an effective strategy for achieving local and systemic control in these patients.

Despite this, some surgical teams continue to advocate for en bloc resection, a more aggressive approach involving complete removal of the lesion with wide margins. Dr Randall underscored that, in the context of low-grade disease confined to the bone, such extensive resections are not routinely indicated and may lead to unnecessary morbidity. He noted that en bloc procedures, although potentially justified in higher-grade or more infiltrative disease, offer no clear advantage over conservative management for low-grade lesions when evaluating recurrence rates and survival outcomes.

For referring medical oncologists and nonsurgical providers, Dr Randall advised close attention to radiographic and pathological descriptors. If imaging reports suggest a low-grade chondrosarcoma and a treating surgical team recommends en bloc resection, he advocated for seeking a second opinion, particularly from orthopedic oncologists experienced in less invasive strategies. In his view, consideration of function-preserving surgical techniques is essential, especially given the long-term implications for patients’ quality of life.

Ultimately, Dr Randall emphasized that intralesional treatment can achieve excellent local control when applied in appropriately selected patients, and that overtreatment should be avoided. He concluded that functional outcomes, especially in anatomically complex regions like the pelvis or proximal extremities, must be prioritized alongside oncologic safety, and that individualized treatment planning remains critical in the management of low-grade chondrosarcoma.