Pelvic bone sarcomas, prognostic factors, and treatment: A narrative review of the literature

Abstract

Primary sarcomas of bone are rare malignant mesenchymal tumors. The most common bone sarcomas are osteosarcoma, Ewing’s sarcoma, and chondrosarcoma. The prognosis has improved over the years, but bone sarcomas are still life-threatening tumors that need a multidisciplinary approach for diagnosis and treatment. Bone sarcomas arising in the pelvis present a unique challenge to orthopedic oncologists due to the absence of natural anatomical barriers, the close proximity of vital neurovascular structures, and the high mechanical demands placed on any pelvic reconstruction following the excision of the tumor. While radiotherapy has an important role especially in Ewing’s sarcoma and chemotherapy for both Ewing’s sarcoma and osteosarcoma, surgery remains the main choice of treatment for all three entities. While external hemipelvectomy has remained one option, the main aim of surgery is limb salvage. After complete tumor resection, the bone defect needs to be reconstructed. Possibilities to reconstruct the defect include prosthetic or biological reconstruction. The method of reconstruction is dependent on the location of tumor and the surgery required for its removal. The aim of this article is to give an insight into pelvic bone sarcomas, their oncological and surgical outcomes, and the options for treatment based on the authors’ experiences.

Limb Salvage and Pelvic Reconstruction With Endoprosthesis After Pelvic Tumor Resection: A Narrative Review

“…Among these tumors, chondrosarcoma is the most prevalent tumor type in adults, while osteosarcoma and Ewing's sarcoma are more common in children. Additionally, destructive tumors like giant cell tumors can also affect the pelvis [ 1 ]. In the past, hindquarter amputation was the standard treatment for these tumors, but it was associated with significant morbidity and major cosmetic and functional impairments [ 2 ].…”

Integrating muscle fiber orientation from visible human data into radiotherapy target volumes

“…For sarcomas that begin in soft tissues, radiotherapy has been associated with a reduction in limb amputation rates (Hoefkens et al 2016). For bone sarcomas, radiotherapy presents an effective alternative to surgery in anatomically challenging areas where resection is not considered feasible without avoiding neurological morbidity, such as the skull base and cervical spine (Banfield 2022, Laitinen et al 2023.…”