Kondrosarkomlu hastaların prognostik faktörleri ve tedavisi: kurumsal deneyim

Abstract

Amaç ve Hedefler: Kondrosarkom (KS) hastalarının prognostik faktörleri ve tedavi yöntemlerine ilişkin veriler sınırlıdır. KS hastalarımızla ilgili deneyimlerimizi sunmayı amaçladık. Gereç ve Yöntemler: 2010-2023 yılları arasında Kanser Enstitümüzde KS tanısı almış 69 hastanın tıbbi kayıtları retrospektif olarak incelendi. Bulgular: Ortanca yaş 47 idi; 93 aylık takipte hafif bir erkek predominansı (%52) gözlendi. Grade 1 (%34) ve 2 (%34) KS'ler en sık görülenlerdi ve alt ekstremiteler (%40) ve pelvis (%26) için bir eğilim vardı. 63 hasta lokalize hastalık, 6 hasta ise metastazla presente oldu. Takip sırasında 13 hastada daha metastaz görüldü. Akciğer en sık metastaz bölgesiydi. Lokalize hastalığı olan 63 hastanın tamamı ameliyat edildi; 7 hasta adjuvan kemoterapi (CT) aldı. 26 hastada nüks görüldü; 9 hasta sistemik kanser tedavisi aldı. Evre 4 hastalık tanısı alan 6 hastanın 5 ine palyatif cerrahi uygulandı, 5 ine CT uygulandı. En sık kullanılan tedavi rejimleri doksorubisin bazlı CT, pazopanib, sirolimus ve selekoksib idi. Takip sırasında metastaz gelişen 13 hastanın 12'si hayatını kaybetti; tanıdan metastaza kadar geçen medyan süre 17,0 (95% CI: 10,8-23,1) ve metastaz sonrası medyan sağ kalım 21,0 (95% CI: 12,7-29,2) aydı. Başlangıçta metastatik olan altı hastanın tamamı hayatını kaybetmişti; medyan progresyonsuz sağ kalım 7 (95% CI: 2,1-11,8) ve genel sağ kalım (OS) 12 (95% CI: 0,00-33,60) aydı. OS, tüm grup için sırasıyla 5, 10 ve 15. yıllarda %75, %63 ve %57 idi. Tek değişkenli analizde kadın cinsiyet, düşük-orta grade, evre 1-2 tümörler uzamış OS ile ilişkiliydi. Çok değişkenli analizde, tanı anındaki evre OS için tek anlamlı faktördü (p=0,002). Sonuç: Yapılan analizler, tümörün erken evrede olmasının iyileşmiş genel sağkalım için önemli bir faktör olduğunu ortaya koydu.

Keywords

• Kemoterapi
• cerrahi
• radyoterapi
• akciğer metastazı
• kondrosarkom

Prognostic factors and treatment of patients with chondrosarcoma: a single institutional experience

Abstract

Aims: Prognostic factors and treatment modalities in chondrosarcoma (CS) remain poorly defined. This study aimed to present our institutional experience with CS patients. Methods: We retrospectively reviewed the medical records of 69 CS patients treated at our Cancer Institute between 2010 and 2023. Results: Median age at diagnosis was 47 years, with a slight male predominance (52%) and a median follow-up of 93 months. Grade 1 (34%) and grade 2 (34%) tumors were most common, predominantly affecting the lower extremities (40%) and pelvis (26%). At presentation, 63 patients had localized disease and 6 had metastases; metastases later developed in 13 additional patients, most frequently in the lungs. All 63 patients with localized disease underwent surgery, and 7 received adjuvant chemotherapy (CT). Recurrence developed in 26 patients, of whom 9 were treated with systemic therapy. Among 6 patients with stage IV disease, 5 underwent palliative surgery and received CT. The most commonly used regimens included doxorubicin based CT, pazopanib, sirolimus, and celecoxib. Among patients who developed metastasis during follow-up, 12/13 died. The median time from diagnosis to metastasis was 17.0 months (95% CI: 10.8–23.1), and median survival thereafter was 21.0 months (95% CI: 12.7–29.2). All six patients metastatic at presentation died, with a median progression-free survival of 7.0 months (95% CI: 2.1–11.8) and OS of 12.0 months (95% CI: 0.0–33.6). OS was 75%, 63%, and 57% at 5, 10, and 15 years, respectively. Female sex, low–intermediate grade, and stage I–II disease correlated with better OS in univariate analysis, but only stage at diagnosis remained significant in multivariate analysis (p=0.002). Conclusion: Our findings highlight that early tumor stage is the only independent predictor of overall survival, underscoring the critical importance of early diagnosis and timely intervention in CS.

Keywords

• Chemotherapy
• surgery
• radiotherapy
• lung metastasis
• chondrosarcoma

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