Dr Randall on the Surgical Management of Low-Grade Chondrosarcoma

"My opinion is that en bloc resections are not indicated [for lower-grade lesions]. If medical oncologists and nonsurgical [providers] are reading a radiology report for a patient that [shows suspected] low-grade chondrosarcoma, and the patient is evaluated by an orthopedic oncologist who wants to perform an en bloc resection, it is fair to say that there is room for another opinion."

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopedic Surgery, chair of the Department of Orthopedic Surgery, and a professor at the University of California, Davis, shared his opinions regarding the role of conservative surgery for patients with low-grade chondrosarcomas.

At the inaugural Birmingham Orthopaedic Oncology Meeting held in January 2024 in Birmingham, United Kingdom, international experts convened to establish consensus guidelines for the optimal management of chondrosarcoma. Among 21 consensus statements reviewed and voted upon by 309 delegates from 53 countries, strong consensus (85% to 99%) was reached on 19 statements. However, no consensus (52%) was achieved regarding the optimal management of intraosseous atypical chondroid tumor/chondrosarcoma, and only moderate consensus (77%) was reached on defining what constitutes a wide surgical margin in this disease.

In this context, the role of conservative surgery in the treatment of low-grade chondrosarcoma remains an area of ongoing debate, Randall stated. Evidence from existing literature supports the use of intralesional curettage followed by bone stabilization for lesions contained within the bone, with demonstrated adequacy in achieving local and systemic disease control, he detailed. Despite this, some orthopedic surgeons remain inclined to pursue en bloc resection, Randall said.

For medical oncologists and referring clinicians interpreting radiology findings suggestive of low-grade chondrosarcoma, it is important to recognize that intralesional management may be both sufficient and preferable in terms of long-term functional outcomes, Randall emphasized. In situations where en bloc resection is proposed for a suspected low-grade lesion, seeking a second opinion from an orthopedic oncologist experienced in conservative management may be appropriate, he advised, explaining that less aggressive resection can help preserve function and quality of life without compromising oncologic control in appropriately selected patients. These differing approaches underscore the need for multidisciplinary communication and individualized treatment planning in chondrosarcoma care, he concluded.