Improving oncological outcomes for pelvic bone sarcomas: Is it possible?

Introduction: Pelvic bone sarcomas are rare, heterogeneous malignancies that present significant diagnostic and therapeutic challenges. Despite advances in imaging, surgical navigation, and multidisciplinary care, it remains unclear whether these innovations have improved outcomes across all histiotypes.

Material And Methods: We conducted a retrospective cohort study of 475 patients surgically treated for primary pelvic bone sarcomas between 2003 and 2022. Patients were stratified into historical (2003-2012) and modern (2013-2022) cohorts. We assessed disease-specific survival (DSS), local recurrence-free survival (LRFS), surgical margin status, reconstruction trends, and adoption of navigation technologies.

Results: Chondrosarcoma (51 %) was the most common tumour, followed by Ewing sarcoma (16 %) and osteosarcoma (11 %). Use of navigation and patient-specific planning significantly increased in the modern cohort, correlating with reduced positive margin rates (8.5 % vs. 21 %; p < 0.001). DSS improved for chondrosarcoma (p = 0.027) and chordoma (p = 0.040), while LRFS improved for chondrosarcoma (p = 0.003), Ewing sarcoma (p = 0.007), and chordoma (p = 0.045). No significant DSS improvement was seen in osteosarcoma or Ewing sarcoma.

Conclusion: Advances in centralization, and technical advances have significantly improved local control and survival, particularly for chondrosarcoma and sacral chordoma. However, outcomes for osteosarcoma and ES remain constrained, highlighting the need for ongoing innovation and multidisciplinary strategies.