# Ten Years of Atypical Cartilaginous Tumors—Is Curettage Really Enough?

## TL;DR

This study compares surgical treatments for atypical cartilaginous tumors and finds that curettage offers similar outcomes to more invasive surgery with fewer complications.

## Contribution

The study provides long-term comparative data on curettage versus wide resection for ACT, supporting less aggressive treatment.

## Key findings

- Local recurrence rates were 8% for wide resections and 16% for curettage, with no significant difference.
- Overall survival was high in both groups (88% for wide resections and 94% for curettage).
- Resection margins and metastases were significant predictors of recurrence and tumor-related death.

## Abstract

Background: Atypical cartilaginous tumors (ACT), formerly classified as Grade 1 chondrosarcomas (CS1) of the extremities, are hyaline cartilage-producing neoplasms. The WHO classification (4th edition, 2013) redefined ACT as locally aggressive rather than malignant tumors, prompting a shift toward less aggressive surgical management. This study reports data of a single, tertiary musculoskeletal tumor center and compares the long-term oncological outcomes of wide resections and intralesional curettage for primary ACT. Methods: This retrospective study included 61 patients with ACT treated at a tertiary tumor center between 2003 and 2023. Patients were divided into two cohorts: Cohort 1 was treated before 2013 with wide or radical resection, while cohort 2 was treated with an intralesional approach. Data on recurrence, revision rates, survival, and predictors of outcomes were analyzed using Kaplan–Meier survival analysis and log-rank testing. Results: Wide resections were performed in 24 patients, requiring prosthetic reconstruction in 76% of cases. Intralesional curettage was performed in 37 patients. Local recurrence occurred in 8% in wide resections versus 16% of curettage cases (p = 0.198), with no significant difference in time to recurrence between cohorts. Unplanned revision rates were higher in the wide resection group (42%) compared to curettage (35%), driven primarily by prosthesis-related complications. Overall survival was high in both groups (88% in wide resections vs. 94% in curettage; p = 0.705). Resection margins, and metastases were identified as significant predictors of both recurrence and tumor-related death. Conclusions: Intralesional curettage provides comparable oncological outcomes to wide resections with reduced morbidity, supporting its use as the preferred treatment for ACT in appropriately selected patients.