Chondrosarcoma

Chondrosarcomas are a group of rare, malignant, primary bone tumours characterised by the production of cartilage. They occur in patients with a wide range of demographics and may develop ‘de-novo’, or from a pre-existing benign cartilage-producing tumour. Chondrosarcomas can be found in almost any bone and may be located centrally (within the medullary canal) or peripherally (arising from the cortex). Patients most commonly present complaining of pain and/or an enlarging bony lump. All suspected chondrosarcomas must undergo appropriate imaging which consists of a plain radiograph and MRI as a minimum. All suspected cases of chondrosarcoma should be discussed with a multidisciplinary team experienced in managing primary bone tumours. A biopsy should be performed in all suspected cases. Chondrosarcomas are generally resistant to systemic oncological treatments and radiotherapy. As a result, the mainstay of treatment revolves around surgery. The type of surgery adopted is dependent on tumour grade. Low-grade (grade 1) tumours may be managed with curettage alone. Higher-grade tumours (grade 2/3) should be resected with wide margins where possible. Following limb-sparing surgery bony defects can be addressed in several ways. Biological reconstruction options in the pelvis include extra-corporeal irradiated autograft, vascularised or non-vascularised autograft, allograft or iliofemoral/ischiofemoral arthrodesis. Pelvic non-biological reconstruction options include custom-designed prostheses, ‘ice cream cone’ prostheses or ‘saddle’ prostheses. In the appendicular skeleton, non-biological custom or modular endoprosthetic replacements are most commonly used, although biological options include autograft (± strut allografting), bone transportation, osteochondral allograft or arthrodesis. Following optimal treatment, the overall 5-year survival rate for chondrosarcoma patients is 75%, although this figure is heavily dependent on tumour grade and subtype.