Local recurrence within the surgical bed, new pulmonary metastases on surveillance CT, ma...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CHONDROSARCOMA-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-CHONDROSARCOMA`
Sources	`SRC-NCCN-NSCLC-2025` `SRC-ONCOKB`

Red Flag Origin

Definition	Local recurrence within the surgical bed, new pulmonary metastases on surveillance CT, malignant transformation of an enchondroma or osteochondroma in Ollier / Maffucci / HME, or pathologic fracture through the tumor — requires re-staging, re-biopsy for grade upgrade or dedifferentiation, and surgical / systemic re-evaluation.
Clinical direction	hold
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "local_recurrence_surgical_bed",
      "value": true
    },
    {
      "finding": "new_pulmonary_metastasis",
      "value": true
    },
    {
      "finding": "enchondroma_malignant_transformation",
      "value": true
    },
    {
      "finding": "pathologic_fracture_through_tumor",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Chondrosarcoma metastasizes preferentially to lung — surveillance chest CT every 6–12 mo for ≥10 years standard. Pulmonary metastasectomy for oligometastatic disease yields long-term survival in ~30% of resected patients (extrapolated from sarcoma literature). Local recurrence post-resection rate is grade-dependent (10% grade I, 50% grade III) — re-biopsy mandatory because grade upgrade and dedifferentiation can change adjuvant strategy. Pathologic fracture requires en-bloc resection (pre-fracture curettage no longer adequate — tumor seeding through fracture hematoma). Ollier / Maffucci patients require lifetime imaging surveillance — ~25% lifetime malignant transformation risk.

Used By

No reverse references found in the YAML corpus.