The literature on musculoskeletal tumors continues to be robust; however, it has been dominated by retrospective observational studies. For bone sarcomas, cytotoxic chemotherapy remains the mainstay of systemic therapy, with no new, effective, targeted biologic interventions. There has been a renewed focus on functional outcomes and socioeconomic factors associated with oncologic outcomes and ongoing interest in pelvic reconstruction, which continues to have high rates of surgical complications. Limb reconstruction with biologic constructs, endoprosthetics, or a combination thereof continues to be successful in limb salvage, with higher revision rates in the pediatric population. With regard to skeletal metastases, there is growing interest in advanced radiation therapy protocols, machine learning algorithms for predicting patient survival, and expansion of the indications for resection and reconstruction rather than internal fixation for long-bone metastases, due to longer life expectancies in many patients with advanced carcinomas.

With regard to soft-tissue sarcoma, several studies have highlighted the importance of early diagnosis and treatment. In addition, cytotoxic chemotherapy remains the mainstay of systemic treatment for advanced disease, with no notable breakthroughs in targeted biologic approaches or immunotherapy. However, an important potential paradigm shift in radiation therapy treatment has been suggested by studies on shorter courses of hypofractionated neoadjuvant radiation therapy, which may allow for the compression of the time frame between diagnosis and the surgical procedure. There has also been some interest in unique soft-tissue sarcoma subtypes and predictors of wound-healing complications. The most exciting advances have been in nonmalignant soft-tissue tumors. Studies have shown successful disease control with targeted biologic therapies for desmoid tumors and tenosynovial giant cell tumors. Finally, there has been a growing interest in intraoperative fluorescence to guide surgical margins in soft-tissue sarcoma.

Bone Tumors Systemic Therapy

Chemotherapy remains the cornerstone of systemic treatment for both Ewing sarcoma and osteosarcoma. In a notable randomized controlled trial, Brennan et al. evaluated chemotherapy regimens in patients with Ewing sarcoma1. Patients were randomized to receive the European regimen consisting of vincristine, ifosfamide, doxorubicin, and etoposide induction, and consolidation using vincristine, actinomycin D, and either ifosfamide alone, cyclophosphamide alone, or busulfan plus melphalan, or to receive the U.S. regimen of vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide induction, plus ifosfamide and etoposide, and consolidation using vincristine and either cyclophosphamide alone or actinomycin D plus ifosfamide, with busulfan and melphalan. The authors demonstrated that the U.S. regimen was more effective, less toxic, and shorter in duration and should be the international standard of care for patients with Ewing sarcoma moving forward.

Oncologic and Functional Outcomes

There is ongoing research focused on the predictors of oncologic outcomes in patients with sarcoma. Richardson et al. examined the relationships between tumor necrosis, survival, and social determinants of health in patients with osteosarcoma2. They found that a tumor necrosis threshold of 90% provided the best prognostic value and lower tumor necrosis levels were associated with worse survival. Lower socioeconomic status and uninsured status were negatively associated with a tumor necrosis level of ≥90%. Kim et al. investigated the clinical presentation of and detection methods for secondary osteosarcoma in patients who had survived retinoblastoma3. The results revealed that these secondary osteosarcomas had a predilection for the diaphysis of long bones and that regular surveillance, such as radionuclide bone scans, was effective in detecting secondary osteosarcomas. In a systematic review and meta-analysis, Gonzalez et al. demonstrated that patients with osteosarcoma presenting with pathologic fractures had lower 3-year and 5-year overall survival rates4. However, patients who presented with a pathologic fracture and underwent a limb-salvage surgical procedure had similar rates of local recurrence compared with patients who underwent amputation, suggesting that a pathologic fracture may not be an absolute contraindication to a limb-salvage surgical procedure.

Several recent studies have explored functional outcomes in patient with primary bone tumors. Gazendam et al. aimed to define minimally important differences for both the Musculoskeletal Tumor Society score and the Toronto Extremity Salvage Score in patients undergoing a limb-salvage surgical procedure and endoprosthetic reconstruction for lower-extremity tumors5. These newly established minimally important differences provide valuable benchmarks for assessing the effectiveness of interventions in this population. Rizkallah et al. demonstrated comparable functional outcomes in patients who underwent proximal femoral replacement with preservation of the greater trochanter and those who underwent direct abductor muscle reattachment6. However, the group with greater trochanter preservation had lower dislocation rates. Gazendam et al. reviewed patients undergoing a limb-salvage surgical procedure and endoprosthetic reconstruction around the knee and evaluated the utility of intraoperative tourniquet use7. They demonstrated that the use of an intraoperative tourniquet was associated with better early functional outcome, as well as a shorter operative time and a reduced length of hospital stay. Ramsey et al. reported on the outcomes of patients who underwent a tibial turnup-plasty for chronic infection following oncologic reconstructions8. They established that this salvage procedure resulted in acceptable function and is a surgical option that can avoid a high transfemoral amputation or hip disarticulation. Finally, Geiger et al. examined the risk factors and outcomes of late amputation in pediatric patients with lower-extremity sarcomas9. They found that both primary and late amputation were associated with decreased physical health-related quality-of-life outcomes.

There is an evolving understanding of how socioeconomic factors can impact outcomes in patients with sarcoma. Fujiwara et al. investigated the relationships between geographic access, institutional treatment volume, and survival in patients with bone sarcomas in the United States10. They found that high-volume facilities (≥20 cases per year) were associated with better survival outcomes. Yatham et al. focused on the association between insurance status and stage at diagnosis of patients with chondrosarcoma in the United States11. Uninsured patients had a significantly higher likelihood of being diagnosed at an advanced stage compared with insured patients. The study underscores the importance of health-care access and the need to address disparities in insurance coverage to improve early detection and outcomes for patients with chondrosarcoma.

Pelvic Reconstruction

The treatment and reconstruction of pelvic tumors continue to be active areas of interest in the literature. Rizkallah et al. reported on the medium-term outcomes of pelvic reconstruction utilizing the LUMiC endoprostheses (Implantcast) and demonstrated low rates of aseptic loosening, with dislocation and infection being the most common major complications12. Xie et al. evaluated the utility of a custom hemipelvic endoprosthesis with preservation of the femoral head in patients with primary bone malignancies and found acceptable function and oncologic outcomes at an early follow-up13. Hinckley et al. retrospectively reviewed patients who underwent pelvic reconstruction with a custom ilium monoflange prosthesis14. They found 92% survivorship at a minimum follow-up of 2 years and concluded that the prosthesis provided durable short-term fixation. Zhang et al. performed a multicenter review of patients who underwent hip transposition after internal hemipelvectomy for periacetabular bone sarcomas15. They demonstrated that most patients were able to regain ambulatory function by 2 months postoperatively and concluded that hip transposition is a viable alternative to endoprosthetic reconstruction in this population. Finally, Dunbar et al. evaluated the impact of psoas muscle size in patients who underwent internal hemipelvectomy without reconstruction16. They established that rehabilitation resulting in increased postoperative psoas size was correlated with improvements in functional outcomes.

Pelvic tumor surgical procedures are fraught with complications, and recent literature has provided insight into potential risk factors. Gonzalez et al. focused on the 30-day soft-tissue complications following the resection of bone and soft-tissue sarcomas of the pelvis17. Older age, hematocrit of <30%, and longer operative time were identified as risk factors for postoperative soft-tissue complications. Bensaid et al. analyzed the risk of surgical site infection in patients undergoing pelvic bone and soft-tissue resection18. They revealed a 41% rate of postoperative surgical site infection and found that extended antibiotic prophylaxis postoperatively did not reduce infection rates. Qu et al. evaluated the position of the acetabular component following periacetabular tumor resection and endoprosthetic reconstruction19. They demonstrated that the hip center of rotation was significantly shifted anteriorly and inferiorly in most patients who sustained a dislocation compared with the patients who did not sustain a dislocation.

Biologic Reconstruction

Biologic reconstruction following the resection of primary bone tumors continues to be a widely utilized technique and an area of active interest. Jamshidi et al. compared osteoarticular allograft alone with allograft-prosthesis composite (APC) reconstruction for skeletally immature patients with distal femoral tumors20. The authors demonstrated that APC reconstructions provided better stability and lower rates of radiographic osteoarthritic changes, whereas the group with allograft alone demonstrated better knee range of motion at the 7-year follow-up. Gundavda et al. provided a detailed description of the Toronto Sarcoma Protocol for reconstructive allograft preparation for long-bone intercalary segment reconstruction21. Jamishidi et al. reported on the utility of fibular strut allografts for skeletally mature patients with pathologic fractures secondary to proximal humeral unicameral bone cysts22. Patients typically had osseous union within 3 months and excellent postoperative functional outcome scores. Syvänen et al. conducted a randomized controlled trial comparing the use of allograft with that of bioactive glass (BG-S53P4; Bonalive) following intralesional curettage of benign bone cysts in 51 pediatric patients23. The authors found comparable recurrence and complication rates between the 2 groups.

Endoprosthetic Outcomes

Endoprosthetic reconstructions remain the mainstay for reconstruction following resection of periarticular bone tumors. El Ghoneimy et al. performed a single-center retrospective review evaluating the survivorship and complications of pediatric patients with cementless distal femoral endoprostheses24. The authors reported an 8-year cumulative incidence of revision surgical procedures of 32%, with hinge breakage being the most common indication for revision, and evidence of radiographic stress shielding in 26% of patients. Geiger et al. reported on the survivorship of both primary and revision cemented distal femoral endoprostheses25. They found that the revision group demonstrated shorter mean implant survival time, with all-cause revision as the end point, and found that a stem diameter of <15 mm was an independent risk factor for all-cause revision. Arnold et al. evaluated the impact of radiation on implant survivorship in patients undergoing lower-extremity endoprosthetic reconstruction26. The authors demonstrated lower mean implant survival time in patients who underwent high-dose radiation compared with patients who underwent no radiation. Tanaka et al. performed a multi-institutional review of pediatric patients with distal femoral bone malignancies who underwent reconstruction with the Compress Compliant Pre-Stress spindle (Zimmer Biomet) paired with an Orthopedic Salvage System expandable distal femoral endoprostheses (Zimmer Biomet)27. The authors found high rates of osseointegration of the Compress spindle but high rates of failure of the expandable endoprosthetic device.

Spinal Bone Tumors

Spinal bone tumors remain a challenging clinical entity. Kolz et al. reviewed a series of patients undergoing treatment for chordomas in the mobile spine and found a poor overall survival of 39% at 5 years28. However, the authors found that surgical resection was beneficial in preventing new neurologic deficits. Similarly, through the California Cancer Registry, Stroud et al. evaluated patients with primary bone malignancies of the mobile spine29. Patients who underwent standard treatment had lower mortality rates when compared with patients who did not undergo any known treatment. Patients who underwent treatment at a National Cancer Institute-designated Cancer Center (NCICC) were more likely to undergo standard treatment protocols.

Giant Cell Tumor

Several recent studies have provided valuable insights into giant cell tumors30–32. In a systematic review, Trovarelli et al. highlighted that multicentric giant cell tumors primarily affect young individuals and often present as metachronous tumors30. Local recurrence and distant metastases were common; multicentric tumors tend to occur in younger people with a metachronous pattern, and this subset of patients with giant cell tumors should be followed closely. Aoude et al. investigated risk factors for tumor relapse in patients with giant cell tumors who underwent joint-salvage procedures31. The authors found that curettage was associated with a higher risk of local recurrence compared with resection. Younger age and tumors in the distal radius were identified as factors contributing to higher rates of recurrence. A repeated joint-salvage surgical procedure was successful in treating the majority of patients with local relapse. Moore et al. evaluated the cytotoxic effects of commonly used irrigation solutions on chondrosarcoma and giant cell tumor cells32. They found that a 0.05% chlorhexidine gluconate solution showed high cytotoxicity, suggesting its potential as a chemical adjuvant during intralesional curettage of both chondrosarcoma and giant cell tumors.

Skeletal Metastases Radiation Therapy Management

There is ongoing interest in the use of novel radiotherapies for the treatment of skeletal metastases. Mascia et al. investigated the feasibility of proton FLASH radiation therapy for symptomatic bone metastases33. The proton FLASH protocol was clinically feasible, had minimal adverse events, and was found to provide pain relief similar to conventional-dose-rate photon radiation therapy. Ryu et al. completed a Phase-3 randomized controlled trial comparing the efficacy of stereotactic radiosurgery with that of conventional radiation therapy for localized vertebral metastases34. The authors demonstrated no superiority of stereotactic radiosurgery compared with conventional radiation therapy with regard to patient-reported pain at the 3-month follow-up.

Surgical Management

The surgical management of skeletal metastases is evolving, and several studies have evaluated various surgical techniques and outcomes in this patient population. Kendal et al. assessed the indications for and survivorship of endoprosthetic reconstruction in patients with extremity metastatic disease35. Endoprosthetic reconstructions were most commonly performed for patients with renal cell carcinoma and demonstrated a low implant failure rate. Johnson et al. evaluated the survivorship of intercalary endoprosthetic reconstruction for diaphyseal bone metastases of the humerus and femur36. They demonstrated a cumulative incidence of implant revision of 11% at 1 year and 16% at 5 years, suggesting adequate survivorship in this patient population. Cevolani et al. evaluated the efficacy of the addition of electrochemotherapy to intramedullary nailing in patients undergoing a surgical procedure for metastatic bone disease37. The authors showed that pain levels decreased significantly, and the risk of local disease progression was low. De Groot et al. reevaluated the Skeletal Oncology Research Group (SORG) machine learning algorithm to predict survival in patients with metastatic bone disease undergoing surgical intervention38. The authors demonstrated that the SORG machine learning algorithm underestimated survival in a contemporary group of patients undergoing innovative immunotherapy and highlighted the importance of periodic reassessment of probability calculators as treatment regimens evolve.

Soft-Tissue Sarcoma Epidemiology and Outcomes Prediction

Several studies assessed epidemiology and predictive factors for outcomes in soft-tissue sarcoma. Brennan and Singer’s historical analysis of sarcoma care at Memorial Sloan Kettering Cancer Center revealed substantial advancements in surgical techniques over 5 decades and improved patient outcomes with limb-sparing surgical procedures and the development of specialized sarcoma surgical teams39. In a retrospective cohort study, Veiga et al. examined the occurrence of and risk factors for treatment-related thoracic soft-tissue sarcomas in breast cancer survivors in the United States40. The findings revealed that breast cancer survivors had an increased risk of developing thoracic soft-tissue sarcoma following radiation therapy, with an overall incidence rate of 4.4 per 10,000 person-years and younger age at breast cancer diagnosis, higher radiation dose, and longer time since radiation therapy as risk factors. This study highlights the importance of careful surveillance and long-term follow-up for breast cancer survivors who have undergone radiation therapy.

Gonzalez et al. examined the prognostic and predictive factors in undifferentiated pleomorphic sarcoma using data from a large tertiary care urban center and found that tumor grade, tumor size, and the presence of lymphovascular invasion were significant prognostic factors associated with overall survival and disease-free survival in patients with undifferentiated pleomorphic sarcoma41. Ryu et al. investigated the effects of time to treatment initiation on outcomes for patients with soft-tissue sarcomas and found that longer time intervals between diagnosis and the surgical procedure or between diagnosis and radiation therapy were linked to poorer outcomes42. Jang et al. examined the impact of insurance status on mortality rates in adults with sarcoma of the extremities and pelvis43. The findings revealed that uninsured and Medicaid-insured patients had higher mortality rates compared with privately insured patients. Finally, Gallina et al. developed a prognostic score for patients with sarcoma and metachronous lung metastases who underwent metastasectomy and found that primary tumor size, histologic subtype, the number of lung metastases, and the presence of extrapulmonary metastases were associated with worse overall survival44.

Systemic Therapy

There have been some notable studies evaluating systemic treatment protocols for soft-tissue sarcoma. Ferrari et al. published a cohort study focused on adolescents and young adults with rhabdomyosarcoma treated using European Paediatric Soft Tissue Sarcoma Study Group protocols45. The authors found that these protocols resulted in favorable outcomes in terms of event-free survival and overall survival rates in this specific age group. Another international study by Freeman et al. was a cost-effectiveness analysis of 4 chemotherapy regimens for advanced AIDS (acquired immunodeficiency syndrome)-associated Kaposi sarcoma in Kenya46. The authors found that paclitaxel-based regimens were the most cost-effective options and could provide meaningful clinical benefits while being affordable in resource-limited settings. Pautier et al. compared the efficacy of doxorubicin alone with the combination of doxorubicin and trabectedin followed by trabectedin alone as the first-line therapy for metastatic or unresectable leiomyosarcoma and demonstrated that the combination therapy followed by trabectedin alone significantly improved progression-free survival compared with doxorubicin alone47. However, there was no significant difference in overall survival between the 2 treatment groups. In a Phase-2 study by Sanfilippo et al., cabazitaxel in patients with metastatic or inoperable locally advanced dedifferentiated liposarcoma had an objective response rate of 11.1% and disease control rate of 83.3%48. The median progression-free survival was 4.5 months, and the median overall survival was 15.8 months.

With regard to new biologic therapies and immunotherapy, Kayton et al. evaluated the use of neoadjuvant pazopanib in nonrhabdomyosarcoma soft-tissue sarcomas and reported a higher risk of major wound complications associated with this treatment approach49. Finally, in a single-center, Phase-2 trial, Somaiah et al. investigated the efficacy and safety of combining the immune checkpoint inhibitors durvalumab and tremelimumab in patients with advanced or metastatic soft-tissue and bone sarcomas50. Their findings demonstrated modest anti-tumor activity with manageable side effects.

Radiation Therapy

With regard to advances in radiation therapy, Guadagnolo et al. conducted a Phase-2 trial evaluating a hypofractionated, 3-week, preoperative radiation therapy regimen for patients with soft-tissue sarcoma51. The study demonstrated that this treatment approach was feasible, with acceptable toxicity levels and promising rates of pathologic response. The authors also reported good local control and overall survival outcomes, indicating the potential effectiveness of this treatment strategy. Laughlin et al. reviewed their long-term experience with an intraoperative electron radiation therapy boost in extremity sarcoma treatment and demonstrated favorable local control rates and overall survival with low rates of toxicity52. Finally, Wang et al. evaluated the clinical outcomes of patients with localized soft-tissue sarcoma treated with neoadjuvant chemoradiotherapy or radiation therapy53. The findings showed that achieving a complete response according to a pathologic evaluation was associated with improved overall survival and disease-free survival. Furthermore, the study demonstrated that the addition of chemotherapy to radiation therapy did not significantly improve outcomes compared with radiation therapy alone.

Unique Soft-Tissue Sarcoma Subtypes

Several studies assessed treatment responses and outcomes in unique soft-tissue sarcoma subtypes. Andreani et al. found that patients with localized synovial sarcomas had better survival outcomes compared with those with metastatic disease and identified tumor size, histological subtype, and surgical margin status as prognostic factors associated with patient outcomes54. Gusho et al. investigated the clinicopathological features and outcomes of 102 patients with extraskeletal myxoid chondrosarcoma using data from the United States Sarcoma Collaborative database55. The authors found that most patients with extraskeletal myxoid chondrosarcoma had localized disease at diagnosis and that these patients had a 5-year overall survival rate of 70%. Houdek et al. assessed the impact of radiation therapy on disease-specific survival in 143 patients with myxoid liposarcoma and found that the lack of response to radiation therapy was associated with poorer disease-specific survival56.

Houdek et al. evaluated the treatment outcomes of patients with extraskeletal Ewing sarcoma and reported that patients who underwent multimodal therapy, including a surgical procedure, chemotherapy, and radiation, had improved overall survival and progression-free survival compared with those who underwent a surgical procedure alone57. The authors also reported that tumor size and the presence of metastasis at diagnosis were significant factors associated with worse outcomes. Finally, Rust et al. reported that wide local excision with clear margins is an effective treatment approach for dermatofibrosarcoma protuberans, leading to low rates of recurrence and good long-term outcomes58. The study also explored the use of Mohs micrographic surgery and found it to be an appropriate treatment option for selected cases of dermatofibrosarcoma protuberans.

Treatment-Related Complications

Complications related to the surgical treatment of soft-tissue sarcoma continue to be an important area of investigation. Hudson et al. analyzed data from the National Surgical Quality Improvement Project to identify risk factors associated with 30-day complications following lower-extremity sarcoma surgery and found that older age, higher American Society of Anesthesiologists (ASA) classification, preoperative radiation therapy, longer operative time, and graft procedures were associated with an increased likelihood of postoperative complications59. Ramsey et al. investigated whether the addition of anaerobic coverage to perioperative antibiotic prophylaxis during soft-tissue sarcoma resection is associated with a reduction in the rate of wound complications and found that the addition of anaerobic coverage did not significantly reduce the proportion of wound complications compared with standard perioperative antibiotic prophylaxis60. In a pilot study, Sabharwal et al. aimed to determine the prevalence of hypercoagulability markers using thromboelastography in patients with musculoskeletal tumors and reported that a large proportion of patients demonstrated thromboelastographic markers of hypercoagulability, suggesting an increased risk of thrombotic events61.

Nystrom et al. investigated the reliability of transcutaneous oximetry as a predictor of wound-healing complications in patients with preoperatively irradiated soft-tissue sarcoma, and found that transcutaneous oximetry measurements were not significantly associated with wound-healing complications62. These results highlight the need for alternative methods or risk assessment tools to accurately predict and prevent wound-healing complications in patients who had undergone preoperative irradiation of a soft-tissue sarcoma. Finally, Thalji et al. analyzed the outcomes of plastic surgical reconstruction in patients with extremity and truncal soft-tissue sarcoma, using data from the U.S. Sarcoma Collaborative, and provided valuable information on the effectiveness of and complications associated with plastic surgical techniques in sarcoma treatment63.

Novel Approaches to Soft-Tissue Tumors Desmoid Tumors

There have been some meaningful advancements in the treatment of desmoid tumors. Gounder et al. investigated the use of nirogacestat, a γ-secretase inhibitor, for the treatment of desmoid tumors and reported that nirogacestat treatment resulted in a substantial response rate and improved progression-free survival in patients with desmoid tumors64. In addition, Pinto et al. demonstrated that the addition of the presence versus absence of CTNNB1 S45F mutations to clinical factors improved the prediction of local recurrence in patients with desmoid tumors65.

Tenosynovial Giant Cell Tumor

The treatment of tenosynovial giant cell tumors continues to be an area of ongoing study. Healey et al. reported the efficacy of pexidartinib with regard to pain relief for patients within the ENLIVEN study and found that pexidartinib treatment resulted in modest pain relief66. In a 20-year cohort study, Spierenburg et al. examined the surgical management of 144 patients with diffuse-type tenosynovial giant cell tumors in a single institution and highlighted the importance of comprehensive surgical approaches in achieving successful outcomes for patients with tenosynovial giant cell tumors67.

Intraoperative Fluorescence Guidance

Other authors have focused on intraoperative strategies to ensure negative-margin resection. Henderson et al. demonstrated that fluorescence guidance enhanced the precision and accuracy of surgical procedures, particularly in the context of tumor resection68. Wang et al. assessed the use of indocyanine green fluorescence imaging to detect residual disease during the surgical procedure for bone and soft-tissue tumors and demonstrated the potential of this imaging technique in identifying residual tumor tissue, allowing for more precise tumor resection69.

The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Randomized Controlled Trial Secondary Analysis Supplement

The PARITY trial was published online in January 2022, and the data set was opened to all investigators to perform secondary analyses70. A total of 13 PARITY secondary analyses were recently published in a JBJS Supplement71–83. These important studies address several exploratory questions, including, among others, the risk factors for surgical site infection and reoperations following lower-extremity endoprosthetic reconstruction, functional outcomes in pediatric patients compared with adult patients, the use of opioids in the orthopaedic oncology population, the use of negative-pressure wound therapy and postoperative drains and the risk for surgical site infection, the risk of thromboembolism following lower-extremity endoprosthetic reconstruction, and biopsy types and their effect on surgical variables and outcomes. Further details of the studies published in the PARITY Trial Secondary Analysis JBJS Collection will be provided in the next Musculoskeletal Tumor Update.

References 1. Brennan B, Kirton L, Marec-Bérard P, Gaspar N, Laurence V, Martín-Broto J, Sastre A, Gelderblom H, Owens C, Fenwick N, Strauss S, Moroz V, Whelan J, Wheatley K. Comparison of two chemotherapy regimens in patients with newly diagnosed Ewing sarcoma (EE2012): an open-label, randomised, phase 3 trial. Lancet. 2022 Oct 29;400(10362):1513-21. 2. Richardson SM, Wurtz LD, Collier CD. Ninety percent or greater tumor necrosis is associated with survival and social determinants of health in patients with osteosarcoma in the National Cancer Database. Clin Orthop Relat Res. 2023 Mar 1;481(3):512-22. 3. Kim Y, Park JW, Cho HS, Jang WY, Han I, Kim HS. Does the clinical presentation of secondary osteosarcoma in patients who survive retinoblastoma differ from that of conventional osteosarcoma and how do we detect them? Clin Orthop Relat Res. 2023 May 5. 4. Gonzalez MR, Bedi A, Karczewski D, Lozano-Calderon SA. Are pathologic fractures in patients with osteosarcoma associated with worse survival outcomes? A systematic review and meta-analysis. Clin Orthop Relat Res. 2023 May 12. 5. Gazendam AM, Schneider P, Bhandari M, Busse JW, Ghert M; on behalf of the PARITY Investigators. Defining minimally important differences in functional outcomes in musculoskeletal oncology. J Bone Joint Surg Am. 2022 Sep 21;104(18):1659-66. 6. Rizkallah M, Araneta KT, Aoude A, Turcotte R. Outcomes after abductor reattachment to proximal femur endoprosthesis after tumor resection. J Am Acad Orthop Surg. 2023 Jan 1;31(1):34-40. 7. Gazendam AM, Schneider P, Vélez R, Ghert M; PARITY Investigators. Tourniquet use in patients undergoing tumour resection and endoprosthetic reconstruction of the knee. Bone Joint J. 2022 Oct;104-B(10):1168-73. 8. Ramsey DC, Fourman MS, Berner EA, Werenski J, Sodhi A, Heng M, Newman ET, Raskin KA, Valerio I, Eberlin KR, Lozano-Calderon S. What are the functional and surgical outcomes of tibial turnup-plasty for salvage in patients with chronic lower extremity infection? Clin Orthop Relat Res. 2023 Jun 1;481(6):1196-205. 9. Geiger EJ, Liu W, Srivastava DK, Bernthal NM, Weil BR, Yasui Y, Ness KK, Krull KR, Goldsby RE, Oeffinger KC, Robison LL, Dieffenbach BV, Weldon CB, Gebhardt MC, Howell R, Murphy AJ, Leisenring WM, Armstrong GT, Chow EJ, Wustrack RL. What are risk factors for and outcomes of late amputation after treatment for lower extremity sarcoma: a childhood cancer survivor study report. Clin Orthop Relat Res. 2023 Mar 1;481(3):526-38. 10. Fujiwara T, Ogura K, Alaqeel M, Healey JH. Geographic access to high-volume care providers and survival in patients with bone sarcomas: nationwide patterns in the United States. J Bone Joint Surg Am. 2022 Aug 17;104(16):1426-37. 11. Yatham P, Garcia J, Fagundo V, Castro G, Rodriguez de la Vega P, Ruiz JG, Belzarena AC. Association between insurance status and chondrosarcoma stage at diagnosis in the United States: implications for detection and outcomes. J Am Acad Orthop Surg. 2023 Feb 15;31(4):e189-97. 12. Rizkallah M, Ferguson PC, Basile G, Kim P, Werier J, Wilson D, Turcotte R. LUMiC® endoprosthesis for pelvic reconstruction: a Canadian experience. J Surg Oncol. 2023 Mar;127(4):727-33. 13. Xie X, Jin Q, Zhao Z, Wang Y, Wang B, Zou C, Yin J, Huang G, Shen J. A novel limb-salvage reconstruction strategy with a custom hemipelvic endoprosthesis and preserved femoral head following the resection of periacetabular tumors: a preliminary study. J Surg Oncol. 2022 Sep;126(4):804-13. 14. Hinckley NB, Beauchamp CP, Christopher ZK, Schwartz AJ, Ogunleye T, Goulding KA. What are the 2-year survivorship outcomes of custom hemipelvis reconstruction after hemipelvectomy and revision arthroplasty? The evolution of a custom ilium “monoflange”. J Surg Oncol. 2023 Mar;127(3):480-9. 15. Zhang L, Iwata S, Saito M, Nakagawa M, Tsukushi S, Yoshida S, Gokita T, Ae K, Nakashima S, Watanuki M, Akiyama T. Hip transposition can provide early walking function after periacetabular tumor resection: a multicenter study. Clin Orthop Relat Res. 2023 May 15. 16. Dunbar NJ, Zhu YM, Madewell JE, Penny AN, Fregly BJ, Lewis VO. Changes in psoas muscle size and ambulatory function after internal hemipelvectomy without reconstruction. Bone Joint J. 2023 Mar 1;105-B(3):323-30. 17. Gonzalez MR, Karczewski D, Bedi ADS, Denwood H, Lozano-Calderon SA. Risk factors for 30-day soft tissue complications after pelvic sarcoma surgery: a National Surgical Quality Improvement Program study. J Surg Oncol. 2023 Aug;128(2):367-74. 18. Bensaid S, Contejean A, Morand P, Enser M, Eyrolle L, Charlier C, Kernéis S, Anract P, Biau D, Canouï E; Other Members of the CRIOACochin Group. Surgical site infection after pelvic bone and soft tissue sarcoma resection: risk factors, microbiology, and impact of extended postoperative antibiotic prophylaxis. J Surg Oncol. 2023 Aug;128(2):344-9. 19. Qu H, Mou H, Wang K, Tao H, Huang X, Yan X, Lin N, Ye Z. Risk factor investigation for hip dislocation after periacetabular tumour resection and endoprosthetic reconstruction via thin-slice CT-based 3D model. Bone Joint J. 2022 Oct;104-B(10):1180-8. 20. Jamshidi K, Bagherifard A, Mirzaei A. A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood: a retrospective study. Bone Joint J. 2022 Oct;104-B(10):1174-9. 21. Gundavda MK, Lazarides AL, Burke ZDC, Tsoi K, Ferguson PC, Wunder JS. Reconstructive allograft preparation for long bone intercalary segments after tumor resections: Toronto Sarcoma protocol. JBJS Essential Surgical Techniques. 2023;13(2):e22.00011. 22. Jamshidi K, Bahradadi M, Bahrabadi M, Mirzaei A. Are fibular allograft struts useful for unicameral bone cysts of the proximal humerus in skeletally mature patients? Clin Orthop Relat Res. 2022 Jun 1;480(6):1181-8. 23. Syvänen J, Serlo W, Jalkanen J, Kohonen I, Raitio A, Nietosvaara Y, Helenius I. Allograft versus bioactive glass (BG-S53P4) in pediatric benign bone lesions: a randomized clinical trial. J Bone Joint Surg Am. 2023 May 3;105(9):659-66. 24. El Ghoneimy AM, Shehab AM, Farid N. What is the cumulative incidence of revision surgery and what are the complications associated with stemmed cementless nonextendable endoprostheses in patients 18 years or younger with primary bone sarcomas about the knee. Clin Orthop Relat Res. 2022 Jul 1;480(7):1329-38. 25. Geiger EJ, Arnold MT, Hart CM, Greig D, Trikha R, Sekimura T, Eckardt JJ, Bernthal NM. What is the long-term survivorship of primary and revision cemented distal femoral replacements for limb salvage of patients with sarcoma? Clin Orthop Relat Res. 2023 Mar 1;481(3):460-71. 26. Arnold MT, Geiger EJ, Hart CM, Greig D, Trikha R, Sekimura T, Eckardt JJ, Bernthal NM. Is high-dose radiation therapy associated with early revision due to aseptic loosening in patients with a sarcoma of the lower extremities reconstructed with a cemented endoprosthesis? Clin Orthop Relat Res. 2023 Mar 1;481(3):475-87. 27. Tanaka KS, Andaya VR, Thorpe SW, Gundle KR, Hayden JB, Duong YC, Avedian RS, Mohler DG, Morse LJ, Zimel MN, O’Donnell RJ, Fang A, Randall RL, Tran TH, New C, Wustrack RL; other members of Study Group FORCE. Survival and failure modes of the Compress® spindle and expandable distal femur endoprosthesis among pediatric patients: a multi-institutional study. J Surg Oncol. 2023 Jan;127(1):148-58. 28. Kolz JM, Wellings EP, Houdek MT, Clarke MJ, Yaszemski MJ, Rose PS. Outcomes of recurrent mobile spine chordomas. J Am Acad Orthop Surg. 2023 Mar 1;31(5):e278-86. 29. Stroud SG, Geiger EJ, Lichtensztajn DY, Goldsby RE, Cheng I, Wustrack R, Theologis AA. Survival of patients with primary osseous malignancies of the mobile spine is associated with access to “standard treatment” protocols. J Am Acad Orthop Surg. 2022 Sep 1;30(17):841-50. 30. Trovarelli G, Pala E, Angelini A, Ruggieri P. A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up. Bone Joint J. 2022 Dec;104-B(12):1352-61. 31. Aoude A, Nikomarov D, Perera JR, Ibe IK, Griffin AM, Tsoi KM, Ferguson PC, Wunder JS. Giant cell tumour of bone. Bone Joint J. 2023 May 1;105-B(5):559-67. 32. Moore C, Fernandes RJ, Manrique J, Polissar NL, Miljacic L, Hippe DS, Vaux J, Thompson MJ. Cytotoxic effects of common irrigation solutions on chondrosarcoma and giant cell tumors of bone. J Bone Joint Surg Am. 2022 Dec 21;104(24):2153-9. 33. Mascia AE, Daugherty EC, Zhang Y, Lee E, Xiao Z, Sertorio M, Woo J, Backus LR, McDonald JM, McCann C, Russell K, Levine L, Sharma RA, Khuntia D, Bradley JD, Simone CB 2nd, Perentesis JP, Breneman JC. Proton FLASH radiotherapy for the treatment of symptomatic bone metastases: the FAST-01 nonrandomized trial. JAMA Oncol. 2023 Jan 1;9(1):62-9. 34. Ryu S, Deshmukh S, Timmerman RD, Movsas B, Gerszten P, Yin FF, Dicker A, Abraham CD, Zhong J, Shiao SL, Tuli R, Desai A, Mell LK, Iyengar P, Hitchcock YJ, Allen AM, Burton S, Brown D, Sharp HJ, Dunlap NE, Siddiqui MS, Chen TH, Pugh SL, Kachnic LA. Stereotactic radiosurgery vs conventional radiotherapy for localized vertebral metastases of the spine: phase 3 results of NRG Oncology/RTOG 0631 Randomized Clinical Trial. JAMA Oncol. 2023 Jun 1;9(6):800-7. 35. Kendal JK, Hamad CD, Abbott AG, Greig D, Trikha R, Christ AB, Wessel LE, Puloski SKT, Monument MJ, Bernthal NM. What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease? J Surg Oncol. 2023 Jun;127(7):1196-202. 36. Johnson JD, Satcher RL, Feng L, Lewis VO, Moon BS, Bird JE, Lin PP. What is the prosthetic survival after resection and intercalary endoprosthetic reconstruction for diaphyseal bone metastases of the humerus and femur? Clin Orthop Relat Res. 2023 Apr 25. Epub ahead of print. 37. Cevolani L, Campanacci L, Staals EL, Dozza B, Bianchi G, De Terlizzi F, Donati DM. Is the association of electrochemotherapy and bone fixation rational in patients with bone metastasis? J Surg Oncol. 2023 Jul;128(1):125-33. Epub 2023 Mar 26. 38. de Groot TM, Ramsey D, Groot OQ, Fourman M, Karhade AV, Twining PK, Berner EA, Fenn BP, Collins AK, Raskin K, Lozano S, Newman E, Ferrone M, Doornberg JN, Schwab JH. Does the SORG machine-learning algorithm for extremity metastases generalize to a contemporary cohort of patients? Temporal validation from 2016 to 2020. Clin Orthop Relat Res. 2023 May 25. Epub ahead of print. 39. Brennan MF, Singer S. Five decades of sarcoma care at Memorial Sloan Kettering Cancer Center. J Surg Oncol. 2022 Oct;126(5):896-901. 40. Veiga LHS, Vo JB, Curtis RE, Mille MM, Lee C, Ramin C, Bodelon C, Aiello Bowles EJ, Buist DSM, Weinmann S, Feigelson HS, Gierach GL, Berrington de Gonzalez A. Treatment-related thoracic soft tissue sarcomas in US breast cancer survivors: a retrospective cohort study. Lancet Oncol. 2022 Nov;23(11):1451-64. 41. Gonzalez MR, Clunk MJ, Bedi ADS, Werenski JO, Lang JH, Karczewski D, Sodhi A, Lozano-Calderon SA. Prognostic and predictive factors in undifferentiated pleomorphic sarcoma: a long-term study from a large tertiary care urban center. J Surg Oncol. 2023 Aug;128(2):322-31. 42. Ryu JH, Rahman J, Deo S, Flint M. Effects of time to treatment initiation on outcomes for soft tissue sarcomas. J Surg Oncol. 2023 Jun;127(7):1174-86. 43. Jang ES, Hammoor B, Enneking FK, Chan CM, Spiguel AR, Gibbs CP, Scarborough MT, Tyler WK. Effect of insurance status on mortality in adults with sarcoma of the extremities and pelvis: a SEER-Medicare study. J Am Acad Orthop Surg. 2023 Jan 1;31(1):e14-22. 44. Gallina FT, Melis E, Bertolaccini L, Spaggiari L, Rocca M, Donati DM, Chiappetta M, Margaritora S, Bertoglio P, Solli P, Mammana M, Rea F, Onesti EC, Ferraresi V, Sperduti I, Ciliberto G, Facciolo F. A prognostic score from a multicentric retrospective analysis of patients affected by sarcoma with metachronous lung metastases undergoing metastasectomy. J Surg Oncol. 2023 May;127(6):1035-42. 45. Ferrari A, Chisholm JC, Jenney M, Minard-Colin V, Orbach D, Casanova M, Guillen G, Glosli H, van Rijn RR, Schoot RA, Cameron AL, Rogers T, Alaggio R, Ben-Arush M, Mandeville HC, Devalck C, Defachelles AS, Coppadoro B, Bisogno G, Merks JHM. Adolescents and young adults with rhabdomyosarcoma treated in the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG) protocols: a cohort study. Lancet Child Adolesc Health. 2022 Aug;6(8):545-54. 46. Freeman EE, McCann NC, Semeere A, Reddy KP, Laker-Oketta M, Byakwaga H, Pei PP, Hajny Fernandez ME, Kiprono S, Busakhala N, Martin JN, Maurer T, Bassett IV, Freedberg KA, Hyle EP. Evaluation of four chemotherapy regimens for treatment of advanced AIDS-associated Kaposi sarcoma in Kenya: a cost-effectiveness analysis. Lancet Glob Health. 2022 Aug;10(8):e1179-88. 47. Pautier P, Italiano A, Piperno-Neumann S, Chevreau C, Penel N, Firmin N, Boudou-Rouquette P, Bertucci F, Balleyguier C, Lebrun-Ly V, Ray-Coquard I, Kalbacher E, Bardet A, Bompas E, Collard O, Isambert N, Guillemet C, Rios M, Archambaud B, Duffaud F; French Sarcoma Group. Doxorubicin alone versus doxorubicin with trabectedin followed by trabectedin alone as first-line therapy for metastatic or unresectable leiomyosarcoma (LMS-04): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2022 Aug;23(8):1044-54. 48. Sanfilippo R, Hayward RL, Musoro J, Benson C, Leahy MG, Brunello A, Blay JY, Steeghs N, Desar IME, Ali N, Hervieu A, Thway K, Marreaud S, Litiere S, Kasper B. Activity of cabazitaxel in metastatic or inoperable locally advanced dedifferentiated liposarcoma: a phase 2 study of the EORTC Soft Tissue and Bone Sarcoma Group (STBSG). JAMA Oncol. 2022 Oct 1;8(10):1420-5. 49. Kayton ML, Weiss AR, Xue W, Binitie O, Hayes Dixon A, Randall RL, Sorger JI, Hawkins DS, Spunt SL, Wang D, Million L, Terezakis S, Choy E, Okuno SH, Venkatramani R, Chen YL, Scharschmidt TJ. Neoadjuvant pazopanib in nonrhabdomyosarcoma soft tissue sarcomas (ARST1321): a report of major wound complications from the Children’s Oncology Group and NRG Oncology. J Surg Oncol. 2023 Apr;127(5):871-81. 50. Somaiah N, Conley AP, Parra ER, Lin H, Amini B, Solis Soto L, Salazar R, Barreto C, Chen H, Gite S, Haymaker C, Nassif EF, Bernatchez C, Mitra A, Livingston JA, Ravi V, Araujo DM, Benjamin R, Patel S, Zarzour MA, Sabir S, Lazar AJ, Wang WL, Daw NC, Zhou X, Roland CL, Cooper ZA, Rodriguez-Canales J, Futreal A, Soria JC, Wistuba II, Hwu P. Durvalumab plus tremelimumab in advanced or metastatic soft tissue and bone sarcomas: a single-centre phase 2 trial. Lancet Oncol. 2022 Sep;23(9):1156-66. 51. Guadagnolo BA, Bassett RL, Mitra D, Farooqi A, Hempel C, Dorber C, Willis T, Wang WL, Ratan R, Somaiah N, Benjamin RS, Torres KE, Hunt KK, Scally CP, Keung EZ, Satcher RL, Bird JE, Lin PP, Moon BS, Lewis VO, Roland CL, Bishop AJ. Hypofractionated, 3-week, preoperative radiotherapy for patients with soft tissue sarcomas (HYPORT-STS): a single-centre, open-label, single-arm, phase 2 trial. Lancet Oncol. 2022 Dec;23(12):1547-57. 52. Laughlin BS, Golafshar MA, Lin K, Goulding K, Roesler K, Vern-Gross T, Seetharam M, Zaniletti I,