Importance of Skeletal Staging in Chondrosarcoma of Bone: Results of Survey on Current Practices Among Musculoskeletal Oncologists

Abstract

Purpose: There are no clear guidelines for staging of conventional chondrosarcoma. We conducted an online survey to determine the current practices for skeletal staging for conventional chondrosarcoma among practicing oncologists and to assess any discrepancy in practices and with the published literature. Methodology: A simple ten-question online survey (e-mails and WhatsApp) was conducted among practicing oncologists over a period of 3 weeks using online portal (surveymonkey.com). It was followed by analysis based on each question to find current practices. Results: 139 members participated in the survey (84% surgeons, 9% radiologists, 3% medical and 3% radiation oncologists and 1% nuclear medicine). 65% have been treating chondrosarcoma for more than 5 years. 88% opined that biopsy is mandatory even if the radiology is suggestive of a chondrosarcoma. 66% said that solitary skeletal metastasis is seen in less than 2% of the cases but 84% of participants were in favour of performing an investigation (bone scan/PET scan) for skeletal survey. While 43% opined skeletal metastasis is more common in recurrent chondrosarcoma, 26% said that performing a bone scan was likely to impact management, 28% said it will not impact management and 46% were unsure. Of the group who thought that a bone scan would impact management or were unsure, the majority (56%) opined that this was relevant only in grade 2 and grade 3 chondrosarcoma. Conclusion: There was lack of consensus regarding staging for chondrosarcoma. Only 26% of respondents were convinced that performing a bone scan was likely to impact management of chondrosarcoma. There is a need to analyze large data sets (retrospective/prospective) to arrive at an evidence-based staging algorithm for chondrosarcoma.