Dedifferentiated Chondrosarcoma: Current Advances and Future Perspectives.

opinion statementDedifferentiated chondrosarcoma (DDCS) remains one of the most aggressive and therapeutically challenging primary bone malignancies. While surgery continues to represent the cornerstone of treatment for localized disease, outcomes remain poor due to high rates of local recurrence and metastatic progression. The role of adjuvant therapies remains less clear. Radiotherapy may be considered in selected patients with unresectable tumors, positive margins, or for symptom palliation, whereas conventional chemotherapy has demonstrated inconsistent and generally limited benefit despite the use of osteosarcoma-based regimens. Recent advances in molecular profiling have improved our understanding of DDCS biology and revealed potential therapeutic opportunities. Recurrent IDH1/2 mutations appear to contribute to tumor progression and dedifferentiation and may represent actionable therapeutic targets. In our practice, comprehensive molecular profiling should be considered whenever feasible, particularly in advanced disease. Emerging evidence suggests that immunotherapy can induce durable responses in a small subset of patients, while early studies combining immune checkpoint inhibitors with antiangiogenic tyrosine kinase inhibitors have demonstrated encouraging response rates that exceed those historically achieved with chemotherapy alone. Although these findings require prospective validation, they support a shift toward biomarker-driven and combination treatment strategies.