Intralesional Versus Wide Resection of Low-Grade Chondrosarcomas of the Hand

Abstract

Purpose: To report our experience with intralesional curettage (resection with positive margins) and amputation (resection with negative margins) of low-grade chondrosarcomas (LCS) of the hand.

Materials and methods: Skeletally mature patients treated surgically for LCS of the hand at our institutions were reviewed. Demographics and oncological history were collected. Results of the entire cohort and by treatment modality were analyzed radiographically, functionally (strength, Disabilities of the Arm, Shoulder, and Hand measure), cosmetically, and oncologically (recurrence, Musculoskeletal Tumor Society score, metastasis, and mortality rates).

Results: Seventeen cases in 16 patients were identified. Nine patients were women. Average age at surgery was 43 years (range, 20-80 years). Mean follow-up was 18 years (range, 9-23 years). Six of the 17 lesions treated at different institutions with intralesional procedures presented as recurrent disease. We treated 3 with a repeat intralesional procedure and the remaining with wide resection. Recurrence incidence was the same in both groups. The remaining 11 new-onset cases were treated with intralesional procedures (6) or wide resections (5). One of the 6 tumors treated with an intralesional procedure recurred. None treated with wide resection recurred. Recurrence incidence combining new- onset and recurrent disease after intralesional procedures was 22% versus 13% for wide resections. Average grip strength was 37 kg (range, 21-55 kg), and pinch strength was 7.6 kg (range, 4.5-12.5 kg). Mean Disabilities of the Arm, Shoulder, and Hand score was 2 (range, 0-10). There were no wound complications, and appearance was satisfactory in most cases (visual analog scale score, > 8). Average Musculoskeletal Tumor Society score was 29 points (range, 21-30 points). No patients presented with metastatic disease or died because of LCS.

Conclusions: Intralesional resections aiming to preserve function are safe, recognizing that more than 1 procedure may be required. Amputation also plays a role with excellent functional outcome in cases in which severe joint deformity or involvement of soft tissues and neurovascular structures interferes with function.

Type of study/level of evidence: Therapeutic IV.

Keywords: Chondrosarcoma; hand; intralesional curettage; low grade; wide excision.