Chondrosarcoma of the head and neck. The UCLA experience, 1955-1988

[Current Therapy Standards for Soft Tissue Sarcomas in the Head and Neck Area - Part 2]

In September 2021, the first version of the German S3 guideline on adult soft tissue sarcomas, version 1.0 (AWMF register number 032/044OL) was presented as part of the oncology guideline program of the DKG, German Cancer Aid and the AWMF. After the basic features of soft tissue sarcomas were presented in Part 1, Part 2 describes the specific options for surgical therapy depending on the location in the head and neck area.

Aggressive Mesenchymal chondrosarcoma of the maxilla: Case report

Introduction

Chondrosarcomas of the head and neck are extremely rare, accounting for approximatively 0.1% of all head and neck malignant tumors. Mesenchymal chondrosarcomas are particularly aggressive, with a high propensity for recurrence.

Case report

We report the case of a 25 years old man with no prior medical history, who presented to our facility with an aggressive tumor of the left maxilla. Upon radiologic and histopathological examinations, the tumor was revealed to be a mesenchymal chondrosarcoma. The patient was treated using surgical excision of the tumor, neoadjuvant chemotherapy and adjuvant radiotherapy.

Conclusion

Due to the high risk of recurrence and the possibility of metastasis occurring long after the initial diagnosis, it is important that patients with mesenchymal chondrosarcomas receive close and regular follow-ups after treatment.

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Maxillary chondrosarcoma generally presents as a painless tissue mass in the nasal cavities.

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In our case, the patient presented with many symptoms on his first consultation due to the advanced stage of tumor extension which has invaded the ipsilateral nasal cavity, the nasopharynx, oropharynx the hard palate and which arrives at the orbit without invading it.

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This case underlines the interest of multidisciplinary consultation because thanks to the decision of a first chemotherapy, the patient could then benefit from a carcinological surgery.

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The interest of a regular long-term follow-up given the high risk of recurrence.

Chondrosarcoma of the jaw: a retrospective series

OBJECTIVES

Low-grade chondrosarcoma presents with features similar to those of benign lesions, such as chondroma and synovial chondromatosis, increasing the difficulty in reaching an accurate diagnosis preoperatively. In this study, we retrospectively reviewed 10 chondrosarcoma cases and evaluated the diagnostic approaches and management modalities.

STUDY DESIGN

Ten cases were included in the present study. We evaluated the clinical features, initial diagnosis, histopathology subtype, immunohistologic markers, final diagnosis, and treatment modalities.

RESULTS

Most of the lesions were found in the mandible. Two cases were followed up for 1 month and 4 years, respectively as benign lesions before malignant changes were detected. With regard to chondrosarcoma histopathology subtypes, 6 cases were identified as conventional chondrosarcoma, whereas 4 cases were diagnosed as mesenchymal chondrosarcoma with aggressive behavior; of these, 3 were associated with local recurrence and metastasis. The immunohistologic markers showed no specificity for chondrosarcoma.

CONCLUSIONS

Distinguishing low-grade chondrosarcoma, particularly in the temporomandibular joint, from benign lesions, such as chondroma or synovial chondromatosis, remains difficult. Currently, the correlation between clinical, radiographic, and histologic features accompanied by close follow-up is extremely important for patients diagnosed with chondrogenic lesions. Postoperative radiotherapy seems to be beneficial in patients with positive surgical margins.

Nasal Chondrosarcoma of the Lower Lateral Cartilage

Head and neck chondrosarcomas are incredibly rare with documented cases arising from skull base, maxilla, larynx, and nasal septum. We present the first reported case of chondrosarcoma arising from the lower lateral cartilage of the nose treated with surgical resection and primary reconstruction.

Review of Current Protocols for Protontherapy in USA

The basis for interest in proton beams by clinical radiation oncologists lies in reduction in treatment volume. The yields from employing a smaller treatment volume are the increase of tumor control probability and the reduction of normal tissues complication probability. The clinical use of proton therapy began in 1954 at Uppsala University in Sweden and in 1961 at Harvard Cyclotron Laboratory in Boston, USA. So far, the total number of worldwide patients treated by protons is about 20,000. In this paper attention will be given to the treatment of patients at the Massachusetts General Hospital-Massachusetts Eye and Ear Infirmary-Harvard Cyclotron Laboratory, and at the Loma Linda University Medical Center. In particular, a review of the literature about the techniques and the results of treatment of skull base and cervical spine chordoma and low-grade chondrosarcoma, skull base meningioma, pituitary tumors, paranasal sinus carcinoma, glioblastoma multiforme, artero-venous malformations, uveal melanoma, macular degeneration, retinoblastoma, thoracic spine-sacrum tumors, and prostate carcinoma is presented. In order to verify and improve the clinical results, the conduct of prospective trials on an inter-institutional basis is essential. To facilitate the conduct of such studies the US National Cancer Institute and the American College of Radiology have established the Proton Therapy Oncology Group (PROG). Several phase III and some phase I-II trials are active at the Massachusetts General Hospital, Harvard Cyclotron Laboratory, and at the Loma Linda University Medical Center.

Management of Nasal Septum Chondrosarcoma Occurring in Elderly: A Case Report

Chondrosarcomas (CS) are tumors affecting mainly pelvis, long bones and ribs in middle aged people; involvement of head and neck is rare and nasal septum location is exceptional. We report the follow-up of an 85-year-old patient suffering from head and neck CS. Magnetic resonance imaging (MRI) showed a mass originating from nasal septum. The patient underwent to debulking surgery and adjuvant hypofractionated radiotherapy with excellent tolerability and no evidence of recurrence after 16 months. Hypofractionated radiotherapy delivered with advanced technique (helical tomotherapy) allowed to deliver high doses radiation in elderly patients with limited toxicity.

Myxoid Chondrosarcoma of Nasomaxilloethmoid Region with Intracranial Extension

Chondrosarcoma of the faciomaxillary area constitute only 4 % of non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, making it one of the rare malignancy (Indian J Otolaryngol Head Neck Surg 60(3):284-286, [1]), with its myxoid variety still rarest. It is a slow-growing tumour, occurring mostly in middle-aged men. Primary chondrosarcoma of the nasal and paranasal sinus region, including the nasal septum, rarely extends into the cranial or intracranial areas unless there is recurrence (Indian J Ophthalmol 41(4):189-191, [2]. When it does occur, early diagnosis is difficult because patients generally present with common, nonspecific sinonasal complaints. A 45 year male patient came to ENT OPD with complaints of epistaxis, diplopia, facial swelling and loosening of teeth. On examination extensive swelling was present involving right maxilla, palate and ethmoid with shifting of Rt eye laterally. FNAC of swelling was non specific infected cystic lesion. On endoscopic examination there was erosion of Rt lateral wall of nose with mucoid material filling maxilla. Its wall was expanded & lined with velvety red mucosa. Maxillary antral biopsy report was myxoid chondrosarcoma. CT scan revealed extensive lesion of maxilla, ethmoid going up to optic nerve and brain. This case of myxoid chondrosarcoma is presented as it is a rare diagnosis. It presented with advanced disease involving nasomaxilloethmoid region and extended up to optic canal and middle cranial fossa. In a thorough review of Indian literature this was a rarely diagnosed tumour.

Sinonasal tract chondrosarcoma: 18-year experience at a single institution

OBJECTIVE

Sinonasal tract chondrosarcomas are considered rare malignancies. Few large series evaluated the clinicopathological characteristics of these tumors. The aim of this study was to describe clinical findings, management and outcome of 24 cases of sinonasal tract chondrosarcoma from a single institution and to focus on the validity and advantage of endoscopic technique compared with conventional surgery.

METHODS

A retrospective analysis of clinical information was performed on 24 patients diagnosed as the sinonasal tract chondrosarcomas between 1994 and 2011.

RESULTS

There were 10 males and 14 females (age range, from 7 months to 67 years; mean age, 34.9 years) in this study. The main complaints were nasal obstruction and swelling/mass. The most common affected sites were maxillary sinus and sphenoid sinus. Except one case of myxoid chondrosarcoma and two cases of mesenchymal chondrosarcoma, 17 patients (70.8%) and 4 patients (16.7%) were, respectively, grade I and II. Three patients were misclassified as other tumors at other hospitals. Two cases had a history of radiation. Five cases superimposed upon a preexisting benign bony conditions. Twenty-three of 24 patients were treated with wide surgical excision, including 15 patients with conventional surgeries by external approach and 8 patients with endoscopic surgeries. Local recurrence was observed in 12 patients. The mean interval of recurrence with endoscopic surgery (37.8 months) was longer than conventional approach (21.9 months), but it did not achieve statistical significance due to small sample size. The 5-year disease-specific survival rate was 83.3%.

CONCLUSION

Chondrosarcomas of the sinonasal tract are rare. The patients with earlier diagnosis and adequate surgical treatment have a more favorable prognosis. Uncontrollable local disease resulting in compression of adjacent critical structures is the most common cause of death.

Management of sinonasal chondrosarcoma: a systematic review of 161 patients

BACKGROUND

This study reviews the published literature related to management of sinonasal chondrosarcoma. Clinical presentation, demographics, radiographic diagnosis, treatment, and management outcomes of this uncommon disease are reported.

METHODS

A systematic review of studies for sinonasal chondrosarcoma from 1950 to 2012 was conducted. A PubMed search for articles related to this condition, along with bibliographies of the selected articles was performed. Articles were examined for patient data that reported survivability. Demographic data, disease site, treatment strategies, follow-up, outcome, and survival were analyzed.

RESULTS

A total of 63 journal articles were included, comprising a total of 161 cases of sinonasal chondrosarcoma. The average follow-up was 77.4 months (range, 1 to 325.2 months). Surgical resection was the most common treatment modality, used in 72.0% of cases. A combination of surgery and radiation therapy was the second most commonly used treatment modality, used in 21.7% of cases.

CONCLUSION

This review contains the largest pool of sinonasal chondrosarcoma patients to date and suggests aggressive surgical resection is the most common treatment modality for this condition. The use of adjuvant radiotherapy for prevention of local recurrence after subtotal or total resection has not been proven effective. However, the use of radiotherapy in addition to surgical resection has shown benefit in some studies in terms of survival.

Orbital chondrosarcoma arising from paranasal sinuses

Orbital chondrosarcoma arising from paranasal sinuses or from the nasal cavity with orbital extension is highly unusual. The aim of this report is to describe our multidisciplinary experience in the treatment of three patients with extensive sino-orbital chondrosarcomas. The patients were aged 43, 75 and 63 years, and the tumors originated from the maxillary, sphenoidal, and ethmoidal sinuses, respectively. Magnetic resonance imaging studies showed homogeneously hypointense lesions on T1-weighted scans, which were hyperintense on T2-weighted images. Intranasal endoscopic surgery alone or in combination with other conventional surgical approaches was the main therapeutic choice. Two patients had recurrences treated with wider surgical removal. Fractionated stereotactic radiotherapy was used in two cases. Two patients had histopathological grade I tumor and one had grade III chondrosarcoma. No patient had regional spread or distant metastasis. All patients were disease-free at 4, 2, and 3 years, respectively, following their last therapeutic interventions. Endoscopic surgery results in lesser morbidity for chondrosarcomas arising from paranasal sinuses and extending into posterior parts of the orbit. However, because control of surgical margins may not be complete, recurrences may occur justifying more radical approaches.

Chondrosarcoma of the maxilla extending to the pterygomandibular space: a case report and review of the literature

Chondrosarcomas are rare tumors of which approximately 10 % are found in the maxillofacial region. They range from a well-differentiated growth resembling a benign cartilage tumor to a high-grade malignancy with aggressive local behaviour and the potential to metastasize. We report a case of high-grade chondrosarcoma of the maxilla extending to the pterygomandibular space which was treated with radical surgical excision without neck dissection and postoperative radiotherapy. The diagnosis was a conventional type of chondrosarcoma, Grade III. The postoperative course was uneventful, and the patient has had no recurrence in the 15-year follow-up period.

[Surgical treatment of head and neck chondrosarcomas]

INTRODUCTION

Head and neck chondrosarcomas may adopt different locations and biological behaviour.

MATERIAL AND METHOD

We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006.

RESULTS

Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach.

CONCLUSION

Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment.

Chondrosarcoma of the nasal septum: A case report

Chondrosarcoma make up only 10-20% of malignant primary bone tumors, with 5-10% located in the head and neck (Downey TJ, Clark SK, Moore DW. Chondrosarcoma of the nasal septum. Otolaryngol Head Neck Surg 2001;125:98-100), and nasal septal chondrosarcoma is extremely rare. Surgical excision is the only curative treatment and radiation and chemotherapy have a limited role for palliation. We used a navigation system in endoscopic surgery without complications for a case of chondrosarcoma of the nasal septum by means of a midfacial degloving approach at primary operation and an external incision approach at salvage operation for local recurrence. To our knowledge, this is the first report of the use of such a system for this surgical approach along with a salvage operation. We discuss the clinical presentation, diagnosis, and treatment of this case as well as present a review of the literature.

Particle beam radiotherapy for head and neck tumors: radiobiological basis and clinical experience

BACKGROUND

Head and neck tumors are often located near critical organs, making it impossible to deliver a dose of conventional radiotherapy high enough to eradicate the disease. Our aim was to review the potential benefits and available clinical experience of particle beam therapy (hadrontherapy) in the treatment of these tumors.

METHODS

A review of the literature was carried out through a MEDLINE search (publications between 1980 and 2005).

RESULTS

A review of the available clinical data shows that particle beam therapy can offer several radiobiological and physical advantages over conventional photon radiotherapy: improved dose distribution permits dose escalation within the target and optimal sparing of normal tissue. Preclinical and clinical studies suggest that there may be benefits to using hadrontherapy for tumors characterized by poor radiosensitivity and critical location. At present, the most used hadrons are protons and, as yet on an experimental basis, carbon ions. It is now well accepted that there are certain indications for using proton therapy for skull base tumors (chordoma and chondrosarcoma), paranasal sinus carcinomas, selected nasopharyngeal tumors, and neutron/ion therapy for salivary gland carcinomas (in particular, adenoid cystic tumors). Its viability in other cases, such as locally advanced squamous cell carcinoma, melanoma, soft tissue sarcoma, and bone sarcoma, is still under investigation.

CONCLUSIONS

Hadrontherapy can be beneficial in the treatment of tumors characterized by poor radiosensitivity and critical location. Further clinical and radiobiological studies are warranted for improved selection of patient population.

Carbon ion radiotherapy of skull base chondrosarcomas

PURPOSE

To evaluate the effectiveness and toxicity of carbon ion radiotherapy in chondrosarcomas of the skull base.

PATIENTS AND METHODS

Between November 1998 and September 2005, 54 patients with low-grade and intermediate-grade chondrosarcomas of the skull base have been treated with carbon ion radiation therapy (RT) using the raster scan technique at the Gesellschaft für Schwerionenforschung in Darmstadt, Germany. All patients had gross residual tumors after surgery. Median total dose was 60 CGE (weekly fractionation 7 x 3.0 CGE). All patients were followed prospectively in regular intervals after treatment. Local control and overall survival rates were calculated using the Kaplan-Meier method. Toxicity was assessed according to the Common Terminology Criteria (CTCAE v.3.0) and the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) score.

RESULTS

Median follow-up was 33 months (range, 3-84 months). Only 2 patients developed local recurrences. The actuarial local control rates were 96.2% and 89.8% at 3 and 4 years; overall survival was 98.2%at 5 years. Only 1 patient developed a mucositis CTCAE Grade 3; the remaining patients did not develop any acute toxicities >CTCAE Grade 2. Five patients developed minor late toxicities (RTOG/EORTC Grades 1-2), including bilateral cataract (n = 1), sensory hearing loss (n = 1), a reduction of growth hormone (n = 1), and asymptomatic radiation-induced white matter changes of the adjacent temporal lobe (n = 2). Grade 3 late toxicity occurred in 1 patient (1.9%) only.

CONCLUSIONS

Carbon ion RT is an effective treatment for low- and intermediate-grade chondrosarcomas of the skull base offering high local control rates with low toxicity.

Myxoid chondrosarcoma of the maxilla in a pediatric patient

Myxoid chondrosarcomas of the head and neck region are rare. We report the case of an 8-year-old boy with progressive unilateral nasal obstruction resulting from a highly differentiated myxoid chondrosarcoma of the maxilla extending to the nasal cavity and the ethmoid. Clinical presentation, histological findings and therapy are presented with a brief review of the literature. This case reaffirms the importance of considering sarcomas or other neoplastic lesions in the differential diagnosis of progressive nasal obstruction in children.

[Treatment with charged particles beams: hadrontherapy part I: physical basis and clinical experience of treatment with protons]

Protons have physical characteristics, which differ from those of photons used in conventional radiotherapy. Better shielding of critical organs is obtained by using their particular ballistic (Bragg peak and lateral narrow penumbra). Some indications as ocular melanoma, chordoma and chondrosarcoma of the base of skull are now strongly accepted by the radiation oncologist community. Others are still in evaluation: meningioma, locally advanced nasopharynx tumor and paediatric tumors. The aim of this review is to present the clinical results of a technic which seems "confidential" because of the rarety and the cost of equipments.

Extraskeletal myxoid chondrosarcoma of the infratemporal fossa: a case report

Extraskeletal myxoid chondrosarcoma is a rare tumour affecting the head and neck. We present a new case located in the midfacial region. Clinical, pathological and therapeutical features are reviewed.

Sarcomas of the head and neck region

PURPOSE OF REVIEW

This review discusses the classification, etiology, diagnosis, evaluation, treatment, and prognosis of sarcoma of the head and neck region.

RECENT FINDINGS

Sarcomas account for less than 1% of all malignancies in the United States with only 5 to 15% of these sarcomas occurring in the head and neck region. However, about 1 in 3 pediatric sarcomas will occur in the head and neck region. Occasionally, these tumors are associated with genetic syndromes or previous radiation exposures, but, most commonly, no clear etiology exists. Pathologic classification is critical to the ultimate treatment and prognosis of sarcoma of the head and neck. Osteosarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma, and angiosarcoma are the most common types of sarcoma to occur in the head and neck region; however, up to 20% of head and neck sarcomas will remain unclassified. Surgery has been central to the management of these malignancies with some exceptions in the pediatric population. Adjuvant chemotherapy is being utilized and/or studied for most high-grade sarcomas and adjuvant radiotherapy is important for disease control in high-grade soft-tissue sarcomas. Prognosis is clearly related to tumor grade and margin status.

SUMMARY

Sarcomas of the head and neck region are rare malignancies often without a clear etiology. Expert pathologic review and classification is critical, as are quality imaging and multidisciplinary management.

Sarcomas of the head and neck

With the exception of pediatric RMS, soft tissue sarcomas only rarely arise in the head and neck region. Soft tissue sarcomas include a diverse array of histologic types because of the variety of mesenchymal tissues from which they originate. The combination of infrequent occurrence, varied pathologic features, and the many potential sites of presentation makes these tumors a challenge for the head and neck oncologist and underscore the need for review by a pathologist experienced with soft tissue tumors. Classification schemes that group sarcomas according to grade have been helpful in providing prognostic information. Although local control of the primary tumor is critical to successful treatment of both high- and low-grade lesions, the high rate of distant metastases in high-grade tumors supports the role of combined modality therapy. Compared with other types of head and neck neoplasms, such as squamous cell carcinoma, soft tissue sarcomas have low rates of regional metastases. Surgery generally has been recommended as the primary method of treatment for achieving local control, except in those high-grade tumors arising in sites not amenable to resection. Exceptions to this principle include RMSs of the orbit, paranasal sinuses, and masticator space in children; these are usually treated with radiotherapy and combined multiagent chemotherapy, thereby avoiding the functional and cosmetic impact of surgery. Also, extensive angiosarcomas of the scalp should be treated with multimodality therapy combining surgery and wide-field radiation therapy in an attempt to achieve local control. Adjuvant radiotherapy is generally recommended for high-grade sarcomas, large tumors, close or positive surgical margins, and certain histologic variants. Systemic chemotherapy is recommended for those tumors with a significant risk of distant metastases. Increasingly, neoadjuvant chemotherapy is being used to determine responsiveness to chemotherapy, which can help physicians select patients who may benefit from systemic postoperative therapy. Traditional predictors of treatment failure for soft tissue sarcomas include larger tumor size, high-grade histology, and positive surgical margins. The advent of more advanced reconstructive techniques, including free tissue transfer, has made more aggressive surgical resection of these tumors possible. Nevertheless, a considerable number of ancillary support staff are critical to the patient's postoperative rehabilitation and eventual return to a satisfactory level of function and quality of life. In the future, the discovery of the molecular pathogenesis of specific tumor types, such as the cytogenetic findings in synovial sarcoma, will improve physicians' prognostic abilities and selection of patients who are most likely to benefit from emerging adjuvant therapies.

National cancer database report on chondrosarcoma of the head and neck

BACKGROUND

Management of chondrosarcoma of the head and neck is largely based on single-institution reports with small numbers accrued over several decades.

METHODS

The American College of Surgeons' National Cancer Data Base included 400 cases of chondrosarcoma of the head and neck diagnosed between 1985 and 1995. Chi square analyses of selected contingency tables and Wilcoxon regression analyses of selected survival stratifications were performed.

RESULTS

Histologic types included conventional (80.8%), myxoid (10.5%), and mesenchymal (8.8%). The mesenchymal and myxoid subtypes were rare among white patients (17.1%) and more common among African-American (31.8%) and Hispanic patients (44.9%). Treatment was most commonly surgery alone (59.5%) and surgery with irradiation (21.0%). Disease-specific survival was 87.2% at 5 years and 70.6% at 10 years. Worse 5-year survival was associated with higher grade (67.3%), regional or distant spread (71.0%), and the myxoid (45.0%) or mesenchymal (53.2%) subtypes.

CONCLUSIONS

Chondrosarcoma of the head and neck encompasses a variety of lesions that differ substantially by demographic and tumor characteristics. Individual tumors can be classified further according to site of origin, histologic subtype, and tumor grade, which can be used to predict biologic behavior and prognosis.

Craniofacial osseous and chondromatous sarcomas in British Columbia--a review of 34 cases

Head and neck sarcomas are very rare diseases. The aim of this study was to assess the prevalence and presentation of hard tissue sarcomas in the head and neck and jaws. A search of the British Columbia Tumor Registry identified 34 craniofacial hard tissue sarcomas (11 chondrosarcomas, 23 osteosarcomas) over a period of 29 years. A male predominance (1.8:1) and a mean age of 40.4 years at diagnosis were seen. Of the 23 patients with osteosarcoma, one-third survived for 5 years and 12 (52%) died within a mean of 20 months. Of the 11 patients with chondrosarcoma, 45% survived for 5 years and two (18%) of the patients died within a mean of 6 months. In nine of the osteosarcoma patients (39%) the jaws were involved, and in six of those cases (67%) there was mandibular involvement. Swelling was the first sign in all jaw patients, with a mean age of 41.1 years at diagnosis and a male predominance with a ratio of 8:1. Three of the eight male patients with osteosarcoma of the jaw (38%) died within a mean of less than 1 year. Improved prognosis is related to early recognition and diagnosis to allow for adequate surgical resection. The benefit of a combination of surgery with irradiation or chemotherapy continues to be investigated.

Chondroid tumors of the larynx: computed tomography findings

PURPOSE

Chondromas and chondrosarcomas of the larynx are rare cartilaginous tumors making up less than 1% of all laryngeal tumors. Patients typically present with symptoms of hoarseness, dysphagia, or dyspnea. The most common location in the larynx for these tumors is the cricoid cartilage. Radiographically, these lesions are typically hypodense, well-circumscribed masses containing mottled calcifications with smooth walls centered within the cartilage.

MATERIALS AND METHODS

We present 6 cases of chondroid tumors of the larynx.

RESULTS

One patient had a chondroma, 4 patients had low-grade chondrosarcomas, and 1 patient had an intermediate-grade chondrosarcoma. Two partial laryngeal resections and 4 total laryngectomies were performed.

CONCLUSIONS

In most cases of chondroma or chondrosarcoma of the larynx, conservative surgery should be attempted, but total laryngectomy may be required for large or recurrent lesions.

Clinical significance of genetic imbalances revealed by comparative genomic hybridization in chondrosarcomas

DNA copy number changes were studied by comparative genomic hybridization (CGH) in 50 chondrosarcoma samples from 45 patients. Mean number of genetic aberrations in primary tumors was 4.8 +/- 1.8. The most frequently gained regions were 20q12-qter (37%), 20q (32%), 8q24.1-qter (27%), 20p (24%), and 14q24-qter (24%). Losses were 5.5 times less frequent than gains and observed mainly at Xcen-q21, 6cen-q22, and 18cen-q11.2 (11% each). Recurrent and metastatic tumors showed a mean of 4.0 +/- 2.2 aberrations per sample. The most frequently gained regions were chromosome 7 (4 cases), 5q14-q32 (4 cases), 6p (3 cases), and 12q (3 cases). Losses of DNA sequences were 3.4 times less frequent than gains. Histological tumor grade was significantly associated with metastasis-free survival (P = .002) and overall survival (P = .003), being the strongest prognostic factor tested. A statistically significant correlation was found between gain at 8q24.1-qter and shorter overall survival (P = .01) but not with local recurrence or metastasis-free survival. Gain at 14q24-qter was associated with a trend to shorter overall survival (P = .05) but neither with an increased risk for local recurrence nor with metastasis-free survival. In a multivariate analysis, only the tumor grade associated with overall survival (P = .02). In a multivariate analysis together with the tumor grade, gain at 8q24.1-qter did not retain its significance (P = .44), indicating that this imbalance is not an independent prognostic factor.

Fibro-osseous, osseous, and cartilaginous lesions of the orbit and paraorbital region. Correlative clinicopathologic and radiographic features, including the diagnostic role of CT and MR imaging

Fibro-osseous and cartilaginous lesions of the orbit and facial region share overlapping clinical, radiologic, and pathologic features that may lead to diagnostic confusion and possible misdiagnosis. The value of imaging studies in the histopathologic diagnosis of these lesions cannot be overemphasized. The histopathologic diagnosis of such lesions should not be rendered in the absence of radiographic correlation.

Particle beam therapy (hadrontherapy): basis for interest and clinical experience

The particle or hadron beams deployed in radiotherapy (protons, neutrons and helium, carbon, oxygen and neon ions) have physical and radiobiological characteristics which differ from those of conventional radiotherapy beams (photons) and which offer a number of theoretical advantages over conventional radiotherapy. After briefly describing the properties of hadron beams in comparison to photons, this review discusses the indications for hadrontherapy and analyses accumulated experience on the use of this modality to treat mainly neoplastic lesions, as published by the relatively few hadrontherapy centres operating around the world. The analysis indicates that for selected patients and tumours (particularly uveal melanomas and base of skull/spinal chordomas and chondrosarcomas), hadrontherapy produces greater disease-free survival. The advantages of hadrontherapy are most promisingly realised when used in conjunction with modern patient positioning, radiation delivery and focusing techniques (e.g. on-line imaging, three-dimensional conformal radiotherapy) developed to improve the efficacy of photon therapy. Although the construction and running costs of hadrontherapy units are considerably greater than those of conventional facilities, a comprehensive analysis that considers all the costs, particularly those resulting from the failure of less effective conventional radiotherapy, might indicate that hadrontherapy could be cost effective. In conclusion, the growing interest in this form of treatment seems to be fully justified by the results obtained to date, although more efficacy and dosing studies are required.

Chondrosarcoma of the larynx: the role of radiotherapy revisited--a case report and review of the literature

BACKGROUND

Experience in the treatment of laryngeal chondrosarcoma is based on about 250 cases reported to date. The standard therapy is conservative surgery. Radiotherapy has universally been regarded as ineffective in the treatment of this disease.

METHODS

A patient with a laryngeal chondrosarcoma was observed for 11 years after radical radiotherapy. The literature on laryngeal chondrosarcoma was critically reviewed, with emphasis placed on radiotherapy.

RESULTS

The review of the literature revealed that experience with radiotherapy of laryngeal chondrosarcoma has been lacking, with fewer than 10 cases with short follow-up documented up to now. Meanwhile, increasing evidence of the efficacy of radiotherapy in the treatment of skeletal chondrosarcoma has emerged. The authors report the first case of chondrosarcoma of the larynx in which radical radiotherapy resulted in a long term remission of more than 10 years.

CONCLUSIONS

Radiotherapy should be considered when radical surgery is not feasible without severe mutilation. It should also be considered for the treatment of residual disease. Laryngectomy should be restricted to salvage treatment when radiotherapy fails. In this study, radiotherapy appeared to be an effective modality in the treatment of low grade laryngeal chondrosarcoma, and these results contrast with the current widespread disapproval of this treatment.

Chondrosarcoma of the nasal septum: skull base imaging and clinicopathologic correlation

Chondrosarcoma arising in the head and neck and craniofacial region is an uncommon lesion. The nasal septum is a particularly rare site of origin, with approximately 30 cases previously reported in the English literature. We present six new cases of chondrosarcoma arising in the nasal septum. Each of these tumors required cranial base surgical approaches for removal. Current imaging techniques allow a very accurate diagnosis to be made before biopsy. The characteristic ring-forming calcifications seen on computed tomography scans can be correlated with the histologic pattern of calcification. Magnetic resonance imaging techniques allow precise definition of tumor extent, which is particularly important because the disease is best treated with primary surgery. Advances in imaging and surgical techniques allow a much more complete tumor removal. It is hoped that this will increase the likelihood of cure in these patients. Surgical management and indications for adjuvant therapy are discussed.

Cartilaginous tumors of the larynx

Cartilaginous tumors of the larynx, while rare, will on occasion be encountered by the otolaryngologist in routine daily practice. True laryngeal chondromas are exceedingly rare, and as a consequence, a putative diagnosis of chondroma should be viewed with suspicion. On pathologic examination, laryngeal chondromas usually prove to be small lesions (less than 2 cm in maximum dimension) and may arise in children or adults. Laryngeal chondrosarcomas, by contrast, usually prove to be larger lesions (exceeding 3 cm in greatest dimension) and are typically found in adults. While high-grade chondrosarcomas are readily identifiable on light microscopic study, the distinction between a chondroma and a low-grade chondrosarcoma is often not so clear-cut. Some low-grade chondrosarcomas may show a slight increase in both cellularity and cytologic atypia when compared with chondromas, but the two patterns often overlap. When faced with a limited biopsy specimen of a laryngeal cartilaginous lesion in which neither increased cellularity nor recognizable cytologic atypia is found, a diagnosis of "cartilaginous tumor without obvious evidence of malignancy--further classification dependent on examination of the lesion in its entirety," or words to this effect, is recommended.