Surgical Treatment of Bone Sarcoma

SIMPLE SUMMARY: Even today, a malignant bone tumor is still a threatening condition for the patient. Such tumors are difficult to treat and they require an interdisciplinary approach to ensure the best possible outcome. This review article provides an overview of the three dominating bone sarcoma entities: osteosarcoma, chondrosarcoma, and Ewing sarcoma. Their prognoses and main pillars of treatment (chemotherapy, radiotherapy, surgery) are laid out with a special focus on the surgical management of this condition. Five cases are described to illustrate different surgical strategies such as biological reconstruction and implantation of a megaprosthesis. Finally, an outline of future developments in the field of tumor surgery is presented with a special focus on technical innovations to help improve surgical outcome and implant survival. ABSTRACT: Bone sarcomas are rare primary malignant mesenchymal bone tumors. The three main entities are osteosarcoma, chondrosarcoma, and Ewing sarcoma. While prognosis has improved for affected patients over the past decades, bone sarcomas are still critical conditions that require an interdisciplinary diagnostic and therapeutic approach. While radiotherapy plays a role especially in Ewing sarcoma and chemotherapy in Ewing sarcoma and osteosarcoma, surgery remains the main pillar of treatment in all three entities. After complete tumor resection, the created bone defects need to be reconstructed. Possible strategies are implantation of allografts or autografts including vascularized bone grafts (e.g., of the fibula). Around the knee joint, rotationplasty can be performed or, as an alternative, the implantation of (expandable) megaprostheses can be performed. Challenges still associated with the implantation of foreign materials are aseptic loosening and infection. Future improvements may come with advances in 3D printing of individualized resection blades/implants, thus also securing safe tumor resection margins while at the same time shortening the required surgical time. Faster osseointegration and lower infection rates may possibly be achieved through more elaborate implant surface structures.