Posters— Medical Oncology

CHEMOTHERAPY FOR METASTATIC CHONDROSARCOMA OF BONE: SINGLE INSTITUTION EXPERIENCE IN 14 PATIENTS

Pink D, Tilgner J, Dörken B, Reichardt P (Department of Hematology, Oncology and Tumorimmunology, Robert-Rössle-Klinik, Universitätsklinikum Charité, Humboldt-University, 13122 Berlin; Germany)

Chondrosarcoma is a rare malignant tumor of cartilage producing cells and the second most common primary neoplasia of bone after osteosarcoma. The majority of patients are between 30 and 60 years of age. The pelvic girdle is the predominant site of primary disease. Most tumors are well differentiated and surgery is the only established treatment option. High grade chondrosarcomas, however, tend to develop distant metastases mainly in the lungs. Chemotherapy for metastatic disease has not been investigated to any extend and published data do not exist beyond occasional case reports.

From 1993 to 1999 14 patients with metastatic chondrosarcoma of bone not amenable to surgical resection of metastases recieved chemotherapy in our institution. The median age of the patients (7 males and 7 females) was 54 years (range 31 to 71). Primary tumors were mainly located in the pelvis (5 patients). Other primary locations were equally distributed between thorax, upper and lower limb (3 patients each). Histology showed high grade lesions in 9 patients, low grade in 2 patients and dedifferentiated chondrosarcoma in 3 patients. Metastases were predominantely located in the lungs (13 cases). One patient presented with liver metastases only. Additional locations were bone, skin, lymph nodes and brain (1 case, respectively). Median time interval from first diagnosis to metastases was 10 months (range 0 to 32).

Chemotherapy consisted of dose-intensive epirubicin / ifosfamide combination in 8 patients, high-dose ifosfamide in 1 patient, doxorubicin, ifosfamide, cisplatin + methotrexat in 4 patients and other anthracyclin based combination in 1 patient. 6 patients recieved second-line chemotherapy with high-dose ifosfamide (3 patients) and cisplatin / gemcitabine (3 patients). 3 patients were treated with oral trofosfamide as maintenance therapy.

Treatment results of first-line chemotherapy were a partial response in 3 patients, stable disease in 5 patients and progression in 6 patients. Response duration was 6, 6 and 12 months. Disease stabilisation lasted from 4 to 12 months. Median overall survival from diagnosis of metastases was 20 months for PR and SD patients (range 6 to 80+) and 10,5 months (range 4 to 34) for patients with progressive disease.

Conclusions: Chemotherapy resulted in a response rate of 21 % and an overall progression arrest rate of 57 %. Response to treatment resulted in a doubling of the overall survival time from 10,5 to 20 months. Chemotherapy should be considered for patients with metastatic chondrosarcoma with inoperable disease or as part of a multimodality treatment regimen.