Baseline organ dysfunction precluding doxorubicin / ifosfamide-based chemotherapy in dedi...

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ID	`RF-CHONDROSARCOMA-ORGAN-DYSFUNCTION`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-CHONDROSARCOMA`
Fontes	`SRC-ESMO-BONE-SARCOMA` `SRC-NCCN-BONE-SARCOMA`

Origem da bandeira vermelha

Definição	Baseline organ dysfunction precluding doxorubicin / ifosfamide-based chemotherapy in dedifferentiated or mesenchymal chondrosarcoma: LVEF <50% (anthracycline contraindicated), CrCl <30 mL/min (ifosfamide nephrotoxicity, MESNA dose constraints), bilirubin >3× ULN (anthracycline metabolism), or DLCO <60% (post-thoracotomy pulmonary reserve concern for surgical resection of pulmonary metastases).
Direcção clínica	de escalonamento
Categoria	disfunção de órgãos

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "comparator": "<",
      "finding": "dlco_percent",
      "threshold": 60
    }
  ],
  "type": "lab_value"
}

Notas

Conventional chondrosarcoma is largely chemo-resistant; the organ- dysfunction flag matters for dedifferentiated subtype (10%) where doxorubicin + ifosfamide adjuvant is extrapolated from soft-tissue sarcoma protocols, and mesenchymal subtype (3-5%) treated with Ewing- type VDC/IE — both anthracycline + alkylator-heavy. LVEF <50: omit doxorubicin or substitute liposomal formulation (limited data). CrCl <30: ifosfamide contraindicated — switch to dose-modified doxorubicin monotherapy or pazopanib for advanced disease. DLCO <60: limits metastasectomy candidacy, important for oligometastatic pulmonary disease.

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