Treatment of Chondrosarcoma

Chondrosarcoma is a cancer that can affect bones, and although it can start in any bone in the body, chondrosarcoma is most often discovered in the arms, legs, or pelvis. After diagnosis, patients often ask whether the tumor can be taken out or removed.

Chrondrosarcoma is most often treated with a combination of surgery and radiation therapy. Complete removal of the tumor is the primary goal of surgery. If the tumor is close to important nerves and blood vessels, surgeons may not be able to remove the whole tumor without risking damage to these vital structures. Following surgery, patients often undergo radiation therapy to lower the risk of tumor recurrence, or prevent growth in known tissue that remains. 

The approach to treating chondrosarcoma is individually tailored to each patient based on their specific circumstances. If surgery is too risky, doctors may treat with radiation therapy alone. If the tumor is small and not causing symptoms, doctors may recommend observation only, as surgery and radiation therapy have their own risks to consider. The decision on how to treat chondrosarcoma and what treatment is best for you will depend on the results of tests like biopsies and imaging scans, severity of symptoms, and your overall health.

As scientific research advances, the approaches to treating chondrosarcoma continue to evolve and improve. Participation in research studies, known as clinical trials, provide opportunities to access new treatments not yet available to the general public. Your medical team can offer information about any ongoing trials conducted at your hospital and explain the potential associated benefits and risks. More information regarding clinical trial participation can be found here.

The surgical approach to treat your chondrosarcoma depends on the tumor’s size and location. Two approaches are typically recommended for skull base chondrosarcomas:

• Endoscopic endonasal surgery: This specialized procedure involves the use of a long, flexible tube with a light and camera attached to its end called an endoscope. The endoscope is inserted through your nose to provide visualization of the area for the surgeon to remove the tumor. This approach is typically used to remove small tumors at the central base of your skull. This technique is minimally invasive and does not require large incisions through the scalp.
• Craniotomy: In this surgical approach, a part of your skull is removed so that doctors can access the tumor. Craniotomy is usually recommended to treat larger tumors that cannot be safely removed using the endoscopic endonasal approach. During a craniotomy, doctors will make an incision in your scalp to access and remove the tumor through the skull.
• Spondylectomy: This is a procedure in which a part of a vertebra, a bone in the spine, is removed. This may be indicated for the removal of spinal chondrosarcoma. During this surgery, the doctor removes a part of or the entire affected vertebra. A bone graft (a piece of bone from another part of your body) or a prosthetic device (like an artificial bone) may be put in its place. The doctor also may insert rods and screws to help stabilize the spine.

When chondrosarcomas are found in the spine, a spondylectomy might be done.

When considering surgery for your chondrosarcoma, it is crucial to select a highly skilled neurosurgeon. Due to the rarity of chondrosarcomas and the intricacies involved in their removal, finding a surgeon with extensive experience performing such surgeries is essential.

Sometimes a second opinion may be helpful. Obtaining advice and insights from another doctor regarding your treatment options is valuable, as different physicians may offer varied perspectives on the most suitable approach. The second surgeon may also affirm your original doctor's recommendations. This can provide reassurance when confronted with a complex surgical procedure.

Chondrosarcoma surgery has risks and complications that can occur depending on the size and location of the tumor, as well as the type of surgery being performed. Besides the risks of bleeding and infection, other risks can include:

• Seizures
• Stroke
• Accumulation of cerebrospinal fluid in the brain (hydrocephalus)
• Neurologic deficits
• Cerebrospinal fluid leak
• Hardware complications

This list is not exhaustive and may not be relevant for your case. It will be important for you to discuss the risks and potential complications with your surgeon. After surgery, you may also need physical rehabilitation to help regain your strength, mobility, and overall functionality.  

After surgery for chondrosarcoma, recovery times can be different for each person, depending on how extensive the surgery was and your overall health. Typically, it takes several months to fully recover, although you should start to feel better within a few weeks.

Right after surgery, you will spend a few days in the hospital. The doctors and nurses will monitor your vital signs and perform regular checkups to make sure there are no complications, or to address any as soon as possible. If there are any problems or complications, you might need to stay in the hospital longer.

During the recovery process, you may feel some discomfort and have limits on what you can do physically. Recovery is a gradual process, which means it takes time. Before surgery, talk to your neurosurgeon about their expectations for your recovery.

Chondrosarcomas located at the base of the skull or in the spine can be challenging to remove completely — only about 30% of patients can have the entire tumor removed. After the tumor is removed, symptoms often improve, and survival time is extended.

For chondrosarcomas that are classified as less aggressive, such as a Grade 1, typically exhibit low recurrence rates after a successful surgery involving complete tumor removal. More than 70% of patients diagnosed with low-grade chondrosarcomas can expect to survive for at least 10 years after the surgery.

However, in the case of more aggressive chondrosarcomas, such as a Grade 3, successful surgery and tumor removal may improve symptoms but is often not curative. In many cases, the cancer has spread to other parts of the body (metastasized) and the chance of long-term survival is less likely. About 30% of patients with high-grade chondrosarcomas can survive for at least 10 years after the surgery.

Talk to your medical team about your desired outcome and personal priorities. With this knowledge, they can help you plan the best way forward based on your medical situation and your goals for the future.

Radiation therapy helps to prevent growth from any remaining cancer cells and lowers the risk of chondrosarcoma recurring after surgery.

When chondrosarcoma spreads to other parts of the body, radiation therapy can still be helpful. It reduces the size of the tumor and slows down the growth of cancer cells. For patients who cannot have surgery to remove the chondrosarcoma, radiation therapy becomes the primary treatment to reduce symptoms and improve quality of life.

To treat chondrosarcoma, radiation therapy uses strong beams of energy to target cancer cells. Radiation therapy can be performed in different ways. The most commonly used form is called external beam radiation, in which the beams come from a machine outside the body. This treatment is given in multiple sessions usually at a hospital or clinic on an outpatient basis, which means that overnight stays are not required.

Another form of radiation therapy that is common utilized is radiosurgery, in which a precisely targeted form of radiation is given in one longer session, although the procedure may be repeated if needed.

A third type of radiation therapy is proton beam radiation therapy. Instead of using x-rays, this method uses beams of protons to target the tumor. Protons can deliver radiation more precisely and cause fewer side effects to healthy tissue around the tumor. However, proton beam radiation therapy is available only at certain specialized centers, so you might need to travel to receive this treatment.

Before starting radiation therapy, know what the process entails. Here are the steps involved to help prepare for radiation therapy to treat chondrosarcoma:

• Consultation: You will meet with a radiation oncologist. They will ask you questions about your health and view your medical records.
• Simulation: To thoroughly plan the radiation treatment, a simulation will be done. You will lie on a table, and a special machine will take pictures of the tumor and the area around it. This helps the doctors know exactly where to aim the radiation.
• Planning: The medical team will use the pictures from the simulation to create a personalized treatment plan just for you. This process can take longer than the actual treatment time.
• Treatment: Radiation therapy is usually done on an outpatient basis, which means overnight stays are not needed. You will lie on the treatment table, and a machine will send radiation to the tumor. The procedure is not painful, and the entire process takes only a few minutes.
• Follow-up evaluation: After finishing radiation therapy, you will have regular appointments with your radiation oncologist and medical team. Your medical team will guide you through the process and answer any questions you have along the way.

Radiation therapy can help treat chondrosarcoma, but you may also experience some side effects, including:

• Feeling tired
• Headaches
• Nausea and vomiting
• Hair loss
• Skin irritation
• Swelling or inflammation
• Memory or concentration difficulties
• Secondary cancer
• Damage to healthy tissues

These risks should be carefully considered when deciding on radiation therapy for treatment. Remember everyone will not have the same side effects. Your medical team will monitor you closely and take steps to minimize any potential problems.

Receiving a diagnosis of chondrosarcoma can be an overwhelming and emotional experience. The journey you are embarking on is undoubtedly challenging. Dealing with the uncertainties, treatment options, and potential side effects can be difficult. It is essential to acknowledge the range of emotions you may be feeling, such as fear, anxiety, and frustration.

Remember that you are not alone in this journey, and there is a team of healthcare professionals, loved ones, and other support networks ready to provide you with the care and support you need. Your strength and resilience will guide you through this difficult time, and there is hope for a brighter future ahead.

• Surgery is the first treatment option, with complete tumor removal being the goal.
• The extent of tumor removal will depend on the size and location of the tumor.
• Radiation therapy is typically used as an adjunct to surgery, to prevent growth from any remaining cancer cells.
• If the tumor cannot be removed surgically, radiotherapy is used instead as the primary treatment method.

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