Surgical Management of Chondrosarcoma

Chondrosarcoma is a type of malignant bone cancer that commonly affects the bones of the arms, legs, and pelvis but can develop from any bone in the body. When first diagnosed, patients often ask if a chondrosarcoma can be removed. Although complete surgical removal is the first choice of treatment, this can be difficult especially if the tumor is in the skull or spine. Your neurosurgeon will collaborate with other medical specialists to create your chondrosarcoma treatment plan. Read on to learn more about the surgical management of chondrosarcoma of the skull and spine.

Treatment for chondrosarcoma involves surgery and radiation therapy. Surgery is often performed initially with the goal being safe and complete tumor removal. If the tumor is near critical nerves and blood vessels, pieces of the tumor may be left behind to preserve these structures. Radiation therapy is then administered after surgery to prevent tumor growth.

Other treatment plans may be recommended depending on your case. For example, if tumor removal is recommended but surgery is too risky, radiation therapy alone may be attempted. Additionally, chondrosarcomas that are small, low grade, and not causing symptoms may simply be monitored over time. The decision to treat a chondrosarcoma and the best treatment for your chondrosarcoma will depend on the results of your biopsy, imaging tests, presence of symptoms, and your overall health.

As ongoing research investigations continue, treatment options and chondrosarcoma treatment guidelines will evolve. Participating in clinical trials can provide access to promising new treatments and therapies that may not be available through standard treatment options. Your medical team can provide you with a list of current trials available at your institution and information about potential benefits and risks.

The exact surgical approach depends on the location and size of your chondrosarcoma. The following are general approaches that may be recommended for chondrosarcomas of the skull base.

• Endoscopic endonasal: This minimally invasive surgical technique allows surgeons to remove a tumor using an endoscope (a thin tube equipped with a light and camera) that is inserted through your nose. This approach may be recommended for small tumors located at the central base of your skull and is associated with reduced recovery time and improved cosmetic outcomes compared with a craniotomy.
• Craniotomy: During this procedure, a portion of the skull is removed to better access the brain. This may be recommended for larger tumors that are more difficult to remove through the endoscopic endonasal approach and will involve an incision on the scalp.
• Spondylectomy: This is a surgical procedure for spinal chondrosarcoma that involves the removal of part of a vertebra, a bone that forms the spinal column. During a spondylectomy, the surgeon removes the affected vertebra or part of it and may replace it with a bone graft or a prosthetic device. Rods, screws, and other pieces of hardware may be inserted to maintain the stability of the spine. Spondylectomy is a complex and risky surgery that requires careful planning and technical prowess.

Choosing a skilled neurosurgeon for your chondrosarcoma surgery is a critical decision that can greatly affect the success of the procedure. Because of the rarity of chondrosarcomas and the complexity of the surgery, selecting an experienced neurosurgeon is crucial. Seeking a second opinion can provide valuable insight into various treatment options and allow you to explore different medical teams.

Risks and complications of chondrosarcoma surgery depend on the size and location of your tumor, as well as the surgical approach. In addition to risks of bleeding and infection, other complications can include:

• Seizures
• Stroke
• Accumulation of cerebrospinal fluid in the brain (hydrocephalus)
• Neurologic deficits (e.g., facial numbness, trouble walking)
• Cerebrospinal fluid leak
• Hardware complications (if used) such as breakage, pull-out or malpositioning

The thought of potentially sustaining nerve injury and being left with a neurological impairment such as weakness, paralysis, or loss of sensation can be worrisome. Physical rehabilitation may be necessary after the operation to regain functioning. The decision to proceed with surgery will require a comprehensive evaluation of the risks and benefits. Discuss any concerns you have about the risks of surgery with your neurosurgeon before the procedure.

Recovery times after chondrosarcoma surgery can vary depending on each case, the extent of the surgery, and your overall health. In general, fully recovering from surgery can last several months, although you may begin to feel better within the first few weeks. After surgery, you will spend several days in the hospital, where you will be monitored for complications and receive medications to help with any pain after the procedure. You may need to stay in the hospital for longer if any complications arise.

The surgical approach may also influence recovery time. Because the endoscopic endonasal approach avoids the need for large incisions or removal of part of the skull, these patients report less pain and can return to normal activities more quickly, although some may experience residual effects such as fatigue or difficulty with certain tasks.

The recovery process is a gradual one, and you may experience some level of discomfort and limitation in mobility during this period. Your neurosurgeon can discuss your expected recovery times before surgery.

Chondrosarcoma located at the skull base or spine are difficult to completely remove. Total resection may occur in only 30% of patients. Adequate removal of tumor is associated with improvement in symptoms and may prolong survival. For low-grade chondrosarcomas (e.g., Grade 1), successful surgical removal of the tumor is associated with low recurrence rates. Greater than 70% of patients with low-grade chondrosarcomas survive at least 10 years after the procedure.

For high-grade chondrosarcomas (e.g., Grade 3), successful surgical removal of tumor may alleviate symptoms; however, metastasis is common and long-term survival rates are generally poor. Approximately 30% of patients with high-grade chondrosarcomas survive at least 10 years after the procedure. It will be important to discuss your treatment priorities with your medical team so that they can help you to plan the best way forward with your goals in mind.

In rare cases, chondrosarcoma can metastasize, or spread, to other parts of the body. This is more likely to occur in high-grade (e.g., Grade 3) chondrosarcomas. Metastatic chondrosarcoma treatment may include radiation therapy and chemotherapy. Surgery may be recommended for localized metastatic tumors, especially to relieve symptoms. The efficacy of chemotherapy in the treatment of chondrosarcoma is limited but may be attempted if all other treatment options have failed.

Patients who receive the difficult news of an advanced or metastatic chondrosarcoma face a difficult decision of whether to undergo aggressive treatments or opt for minimal treatments to prioritize quality of life. It can be helpful to engage in discussions with family, friends, and support groups to gain insight and support as you navigate through this challenging journey. Ultimately, the decision should be based on your individual needs, goals, and values.

• Chondrosarcoma is a type of bone cancer that can also occur in the brain and spine.
• Surgery is the first choice of treatment, although complete removal is often difficult.
• The recovery process after chondrosarcoma surgery is a gradual one and may require physical rehabilitation.

• Sarcoma Foundation of America
• The Liddy Shriver Sarcoma Initiative
• Chondrosarcoma Foundation
• National Brain Tumor Society
• American Brain Tumor Association