A 58-year-old man has a Grade II chondrosarcoma arising in the proximal femur. Regarding its management, which statement is correct?
- A Wide surgical resection is the mainstay, as both chemotherapy and radiotherapy have little effect ✓
- B Neoadjuvant chemotherapy improves survival and should precede surgery
- C Intralesional curettage with cementation is adequate definitive treatment
- D Radiotherapy is the primary treatment, with surgery reserved for residual disease
Correct answer: A. Wide surgical resection is the mainstay, as both chemotherapy and radiotherapy have little effect
Explanation
Chondrosarcoma is notoriously resistant to both chemotherapy and radiotherapy because of its low cellularity, abundant cartilaginous matrix, and poor vascularity. Wide or radical surgical excision with clear margins is therefore the definitive treatment and the main determinant of survival. Curettage is inadequate for a Grade II lesion, unlike some low-grade intralesionally managed cases, and radiation is considered only for unresectable sites such as the skull base or spine where margins cannot be achieved.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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