Purpose: This retrospective analysis was based on observations in 15 patients, seven men and eight women, mean age 48 years (19–72) treated between 1988 and 2000 at the Curie Institute. The tumour was located in limbs in eight patients (one humerus, two femurs, four tibias, one fibula), in the axial skeleton in five (four pelvi, one sacrum), and in the rib cage and the scapula in one each. Histology examination of the dedifferentiated component displayed fibrosacroma in six cases, HFM in two, rhabdomyosarcoma in two and leiomyosarcoma and osteosarcoma in one each. Six patients were given neoadjuvant and adjuvant chemotherapy of the osteosarcoma type and underwent conservative surgery of the affected limb in three out of four cases. Total histological necrosis was observed in three out of six cases. Six patients were given adjuvant treatment alone using an osteosarcoma protocol. Three unoperable patients were given palliative chemotherapy and radiotherapy.

Results: Nine patients died from their disease. The most frequent metastatic site was the lung; mean survival was 20 months. Six patients survived including five with no progression (1+, 5+, 6+, 7+, 12+ years). Three out of five had had preoperative chemotherapy with a complete histological response and two out of five had had osteosarcoma protocol adjuvant chemotherapy.

Conclusion: Dedifferentiated chondrosarcoma is generally considered to have very poor prognosis and should lead to an adapted therapeutic strategy. In our series, the osteosarcoma protocol provided complete histological response in three out of six patients. Five patients had prolonged survival, all had been given an osteosarcoma type chemotherapy protocol.

Purpose: We report cancerological and functional outcome in 41 patients who underwent interilioabdominal disarticulation for malignant tumours.

Material and methods: This retrospective series included 27 men and 14 women, mean age 49 years, most of whom underwent surgery for chondrosarcoma. In ten patients, the disarticulation followed a resection-reconstruction procedure. In five patients, it followed curettage or contaminated margin resection. For seven patients it was performed after radiotherapy alone. None of the patients had metastatic dissemination prior to surgery. The resection margins were in healthy tissue in 24 cases and contaminated in 17. Mean follow-up was 62 months.

Results: Twenty-eight patients died from their disease and one died from pulmonary embolism. At last follow-up, among the 13 living patients, five had local or general relapse. For the 17 patients who had contaminated resection margins, ten developed a recurrent tumour compared with five recurrent tumours among the 25 patients with resection margins in healthy tissue. Mean five-and ten-year survival rates were 30% and 25% respectively. Initial treatment, tumour size and tumour histology did not have any significant effect on prognosis. The only factor with a significant effect on survival was the quality of the resection margins. All patients were able to walk with two crutches.

Discussion: Interilioabdominal disarticulation is a very mutilating procedure. Since the development of conservative surgery of the pelvis, indications for interilioabdominal disarticulation are generally limited to very voluminous endopelvic tumours with vessel and nerve invasion. For local recurrence after surgical resection of the pelvis or proximal femur, especially in patients with infection or radiated tissue, interilioabdominal disarticulation may be the only solution providing satisfactory cancerological resection. Careful exploration of the locoregional and general extension is necessary before proposing this mutilating procedure, with its inherent psychological and functional impact, in order to properly select patients free of metastasis who could benefit from the cancerological resection provided by inter-ilioabdominal disarticulation.