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J Thorac Cardiovasc Surg 2009;137:610-614
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Surgical treatment is decisive for outcome in chondrosarcoma of the chest wall: A population-based Scandinavian Sarcoma Group study of 106 patients

Division of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden

Received for publication March 20, 2008; revisions received May 26, 2008; accepted for publication July 17, 2008.

^_* Address for reprints: Prof. Henrik C. F. Bauer, MD, PhD, Karolinska University Hospital, Department of Orthopaedics, 171 76 Stockholm, Sweden. (Email: bjorn.widhe{at}ki.se).

Objectives: Chondrosarcoma of the chest wall is the most frequent primary malignant chest wall tumor. Surgery remains the only effective treatment. Sarcoma treatment in Sweden is centralized to sarcoma centers; however, sarcomas of the chest wall have also been handled by thoracic and general surgeons.

Methods: One hundred six consecutive reports of chondrosarcomas of the rib and sternum over a 22-year period (1980 to 2002) were studied, with a median of 9 (4 to 23) years of follow-up for survivors. Clinical files were gathered and pathologic specimens reviewed and graded 1 to 4 by the Scandinavian sarcoma pathology group. Surgical margins were defined as wide, marginal, or intralesional.

Results: Ninety-seven patients were treated with a curative intent. Patients operated with wide surgical margins had a 10-year survival of 92% compared with 47% for those with intralesional resections. The 10-year survival was 75% for patients treated at sarcoma centers and 59% for those treated by thoracic or general surgeons. Local recurrence rate was highly dependent of the surgical margins—4% after wide resections and 73% after intralesional resections. The proportion of intralesional resections was higher outside sarcoma centers. Prognostic factors (multivariate analysis) for local recurrence included surgical margin and histological grade; for metastases, prognostic factors included histologic grade, tumor size, and local recurrence. Metastases occurred in 21 of the patients and only 2 were cured.

Conclusions: Patients operated with wide surgical margins resulted in fewer local recurrences and better overall survival. Patients with chest wall tumors should be referred to sarcoma centers and not to general thoracic surgery clinics for diagnosis and treatment.