The clinical approach towards chondrosarcoma
The clinical approach towards chondrosarcoma
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DOI：
10.1634/theoncologist.2007-0237
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发表时间：
2008-01-01
期刊：
影响因子：
5.8
通讯作者：
Bovee, Judith V. M. G.
中科院分区：
文献类型：
--
作者：
Gelderblom, Hans;Hogendoorn, Pancras C. W.;Bovee, Judith V. M. G.
本文综述了骨软骨肉瘤的组织病理学、分类、诊断方法和治疗方法。新发的软骨肉瘤是原发性软骨肉瘤，而合并于已存在的良性软骨肿瘤（如内生软骨瘤或骨软骨瘤）的软骨肉瘤被称为继发性软骨肉瘤。常规软骨肉瘤可根据其在骨中的位置分为中央、外周和近皮质软骨肉瘤。组织学分级与预后有关；然而，它也受制于观察者之间的可变性。罕见的软骨肉瘤亚型，包括去分化、间充质和透明细胞软骨肉瘤，也进行了讨论。磁共振成像是必要的划定骨内和软组织受累的程度，术前。尤其建议对骨盆和其他扁平骨进行计算机断层扫描，因为这些部位可能难以辨别骨破坏的模式和基质矿化的存在。广泛、整体切除是中高级别软骨肉瘤的首选手术治疗方法。在局限于骨的低级别软骨肉瘤中，广泛的病灶内刮除，局部辅助治疗和骨移植物填充腔具有良好的长期临床效果和令人满意的局部控制。软骨肉瘤相对耐放疗；因此，在不完全切除后，需要bb0 ~ 60gy的剂量来达到局部控制。在这种治疗情况下，用质子或其他带电粒子照射似乎是有益的。化疗仅可能对间充质软骨肉瘤有效，对去分化软骨肉瘤的疗效不确定。潜在的新的全身治疗靶点正在讨论中。
This review provides an overview of the histopathology, classification, diagnostic procedures, and therapy of skeletal chondrosarcoma. Chondrosarcomas that arise de novo are primary chondrosarcomas, whereas chondrosarcomas developing superimposed on pre- existing benign cartilage neoplasms such as enchondromas or osteochondromas are referred to as secondary chondrosarcomas. Conventional chondrosarcomas can be categorized according to their location in bone into central, peripheral, and juxtacortical chondrosarcomas. Histological grading is related to prognosis; however, it is also subject to inter-observer variability. Rare subtypes of chondrosarcoma, including dedifferentiated, mesenchymal, and clear cell chondrosarcoma, are discussed as well. Magnetic resonance imaging is necessary to delineate the extent of the intraosseous and soft tissue involvement preoperatively. Computed tomography is especially recommended in the pelvis and other flat bones where it may be difficult to discern the pattern of bone destruction and the presence of matrix mineralization. Wide, en- bloc excision is the preferred surgical treatment in intermediate- and high- grade chondrosarcoma. In low- grade chondrosarcoma confined to the bone, extensive intralesional curettage followed by local adjuvant treatment and filling the cavity with bone graft has promising long- term clinical results and satisfactory local control. Chondrosarcomas are relatively radiotherapy resistant; therefore, doses > 60 Gy are needed in attempts to achieve local control after incomplete resection. Irradiation with protons or other charged particles seems beneficial in this curative situation. Chemotherapy is only possibly effective in mesenchymal chondrosarcoma, and is of uncertain value in dedifferentiated chondrosarcoma. Potential new systemic treatment targets are being discussed.