TN 7 (08-12)

DI 23022.705 Chondrosarcoma—with multimodal therapy

COMPASSIONATE ALLOWANCE INFORMATION

CHONDROSARCOMA

ALTERNATE NAMES

Chondrosarcoma Grade III; Dedifferentiated Chondrosarcoma; Mesenchymal Chondrosarcoma

DESCRIPTION

Chondrosarcoma is the second most common form of bone cancer that primarily affects people over 40 years old, although it sometimes affects younger adults, adolescents, and children. It usually originates in the legs, arms, shoulder blades, ribs, pelvis, or pelvic bones, but may be found in any bone and sometimes outside of the bones (e.g., adjacent muscles). Chondorsarcoma with multimodal therapy indicates that the response to treatment has been poor and requires a combination of chemotherapy, surgery, and radiation therapy before or after surgery.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Diagnostic testing: Diagnostic testing for chondrosarcoma includes x-rays, CT or MRI imaging to identify the tumor. A biopsy confirms the diagnosis.

Physical findings: Physical findings of chondrosarcoma vary, depending on the location and size of the tumor. Individuals may experience pain, swelling or a lump at the tumor site, unexplained weight loss, fatigue, difficulties breathing, fatigue, and fever or night sweats.

ICD-9: 170

ONSET AND PROGRESSION

Chondrosarcoma usually begins as a single tumor. Spread (metastases) to other parts of the body is common if the disease progresses to grade III, dedifferentiated, or mesenchymal chondrosarcoma. Inoperable, unresectable, and metastatic chondrosarcomas have poor prognoses, with less than a third of patients surviving five years.

TREATMENT

Surgery is the main treatment. Doctors may also use adjuvant chemotherapy if the cancer has spread. Recurrent chondrosarcoma may require surgery and radiation, and perhaps ablation treatments (e.g., liquid nitrogen or heating probes) to remove residual tumor.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for evaluation: The adjudicator needs medical evidence that specifies the type, extent, and site of the primary, recurrent, or metastatic lesion. Biopsy or needle aspiration information found in operative notes, pathology reports, summaries of hospitalization or other medical reports that include details of the surgical and pathological findings.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

13.11D

113.03

Chondrosarcoma in adults treated with multimodal therapy meets 13.11D without regard to effectiveness of treatment. Pediatric chondrosarcoma meets listing 113.03.

Medical Equals

  

* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.


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http://policy.ssa.gov/poms.nsf/lnx/0423022705
DI 23022.705 - Chondrosarcoma--with multimodal therapy - 08/10/2012
Batch run: 08/10/2012
Rev:08/10/2012