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Sarcoma Management in Orthopaedic Oncology
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Sarcoma Management in Orthopaedic Oncology

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 20 June 2026 | Viewed by 6682

Special Issue Editors

Prof. Dr. Vasileios Kontogeorgakos

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12461 Athens, Greece
Interests: orthopaedic surgical oncology; bone and soft tissue sarcoma; paediatric sarcomas; microsurgery; musculoskeletal oncology
Prof. Dr. Jendrik Hardes

E-Mail Website
Guest Editor
Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
Interests: orthopaedic surgery; sarcoma surgery; musculoskeletal oncology; soft tissue sarcoma

Special Issue Information

Dear Colleagues,

Cancer is a leading cause of morbidity and mortality worldwide. Significant efforts to improve disease diagnosis and treatment are currently underway, with the aim of improving patients’ health, quality of life, and survival. Previously, sarcomas, representing a minority of cancer diagnoses in children and adults, received less attention from the medical community. However, over the last two decades, there has been a clear and impressive increase in knowledge on sarcoma biology, histology, adjuvant therapies, and surgical procedures. As a result, health care quality and patients’ survival and daily living activities have been greatly improved. This is the result of the combined work of researchers in basic science and in clinical settings.

Our aim in launching this Special Issue is to provide an overview of the current landscape of treatment and diagnosis in sarcoma in both children and adults and to provide directions for future investigations.

Prof. Dr. Vasileios Kontogeorgakos
Prof. Dr. Jendrik Hardes
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • orthopaedic surgical oncology
  • sarcoma
  • orthopaedic surgery
  • bone and soft tissue sarcoma
  • diagnose
  • neoadjuvant therapy
  • targeted therapy
  • immunotherapy

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Published Papers (5 papers)

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Research

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14 pages, 638 KB  
Article
Diagnostic Accuracy of Synovial Calprotectin in Megaprosthetic Reconstructions: A Prospective Cohort Study from a Tertiary Sarcoma Center
by Panayiotis Gavriil, Pavlos Altsitzioglou, Ioannis Trikoupis, Efthalia Maleka, Panagiotis Briassoulis, Jendrik Hardes, Panayiotis Papagelopoulos and Vasileios Kontogeorgakos
Cancers 2026, 18(10), 1511; https://doi.org/10.3390/cancers18101511 - 8 May 2026
Viewed by 356
Abstract
Background/Objectives: Diagnosing periprosthetic joint infection (PJI) after megaprosthetic reconstruction may be difficult due to altered inflammatory responses, extensive prior surgery, and the limited performance of conventional criteria such as the 2018 ICM score. Synovial calprotectin is a rapid neutrophil-derived biomarker that may improve [...] Read more.
Background/Objectives: Diagnosing periprosthetic joint infection (PJI) after megaprosthetic reconstruction may be difficult due to altered inflammatory responses, extensive prior surgery, and the limited performance of conventional criteria such as the 2018 ICM score. Synovial calprotectin is a rapid neutrophil-derived biomarker that may improve diagnostic accuracy in this challenging setting. The primary aim of this study was to evaluate the diagnostic performance of synovial calprotectin in detecting periprosthetic infection in patients treated with tumor megaprostheses; secondary aims included comparison with ICM classification, assessment in infection classification-inconclusive cases, and exploratory performance in patients with low CRP. Methods: This prospective study included 20 consecutive megaprosthesis patients evaluated for suspected PJI at ATTIKON University Hospital, Athens, with a minimum follow-up of 1 year after biomarker testing. Synovial calprotectin was measured using a lateral-flow assay (positive ≥ 50 mg/L) and compared with a predefined infection reference standard. ICM final status (0 = aseptic, 1 = inconclusive, 2 = infected) was recorded for all cases. Other synovial biomarkers (α-defensin, leukocyte esterase, synovial D-dimer) were not routinely available. The cohort had a mean age of 52.9 ± 22.5 years, 70% were male, and reconstructions involved the knee (80%), hip (15%), and humerus (5%). Preoperative cultures were positive in 40%, the median systemic WBC was 7100/μL, and the median time from last surgery to testing was 1.0 years (IQR 0.46–2.0). Among infected cases, the most common microorganisms were coagulase-negative staphylococci (61.5%) and Staphylococcus aureus (23.1%), with 30.8% demonstrating polymicrobial infection. Results: Thirteen of 20 patients (65%) were classified as infected. Using the ≥50 mg/L threshold, synovial calprotectin demonstrated high apparent diagnostic accuracy in this exploratory cohort, and no false positives, yielding a sensitivity of 92.3%, specificity of 100%, PPV of 100%, NPV of 87.5%, LR+ = ∞, and LR− = 0.08. The AUC for continuous values was 1.00. Agreement with the ICM final classification was substantial (κ = 0.76), with no directional discordance (McNemar p = 1.00). Among the three ICM-inconclusive cases, calprotectin correctly reclassified two (66.7%). In patients with low CRP (<10 mg/L), a clinically difficult subgroup, calprotectin maintained strong performance (sensitivity 75%, specificity 100%, NPV 85.7%). Conclusion: Synovial calprotectin demonstrated promising diagnostic performance for PJI in megaprosthesis patients, with high sensitivity and specificity, and substantial agreement with the 2018 ICM criteria. It successfully clarified most ICM-inconclusive cases and remained reliable even in patients with low CRP. These findings support calprotectin as a valuable adjunctive biomarker in the complex diagnostic environment of megaprosthetic reconstruction and justify further validation in larger cohorts. Full article
(This article belongs to the Special Issue Sarcoma Management in Orthopaedic Oncology)
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9 pages, 227 KB  
Article
Functional Outcomes and Recurrence After Arthroscopy-Based Treatment of Pigmented Villonodular Synovitis of the Knee: A 20-Year Single-Center Series
by Efstathios Konstantinou, Alexandros Koskiniotis, Antonios Koutalos, Konstantinos Malizos, Theofilos Karachalios and Michael Hantes
Cancers 2026, 18(7), 1178; https://doi.org/10.3390/cancers18071178 - 7 Apr 2026
Viewed by 587
Abstract
Background/Objectives: Tenosynovial giant cell tumor (TGCT), historically referred to as pigmented villonodular synovitis (PVNS), is a rare proliferative synovial disorder that most commonly affects the knee and may lead to progressive joint damage. Surgical synovectomy remains the mainstay of treatment, although recurrence [...] Read more.
Background/Objectives: Tenosynovial giant cell tumor (TGCT), historically referred to as pigmented villonodular synovitis (PVNS), is a rare proliferative synovial disorder that most commonly affects the knee and may lead to progressive joint damage. Surgical synovectomy remains the mainstay of treatment, although recurrence remains a concern, particularly in diffuse disease. The purpose of this study was to evaluate functional outcomes and recurrence following arthroscopic synovectomy with selective open excision for TGCT of the knee. Methods: This retrospective case series included patients treated surgically for TGCT of the knee at a single tertiary orthopaedic center between 2003 and 2023. The extended study period may have introduced variability in surgical technique and perioperative management due to evolving clinical practice. All patients underwent arthroscopic synovectomy, with open excision performed when necessary to address posterior or extra-articular disease not amenable to complete arthroscopic resection. Functional outcomes and knee range of motion were evaluated preoperatively and at final follow-up. Recurrence and complications were recorded. Results: A total of 43 patients were included with a mean follow-up of 8.1 years. Diffuse TGCT was present in 32 patients (74%), while 11 patients (26%) had localized disease. Arthroscopic synovectomy was performed in all cases, with additional open excision required in 10 patients. Functional scores and range of motion improved significantly at final follow-up (p < 0.001). Disease recurrence occurred in 8 patients (18.6%), all with diffuse disease, and was treated with revision arthroscopic synovectomy. Conclusions: Arthroscopic synovectomy with selective open excision when required was associated with significant improvement in functional outcomes and knee range of motion. Disease recurrence occurred in 18.6% of patients and exclusively in those with diffuse disease, emphasizing the need for careful postoperative surveillance. Full article
(This article belongs to the Special Issue Sarcoma Management in Orthopaedic Oncology)
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13 pages, 2448 KB  
Article
Pelvic Floor Functionality and Outcomes in Oncologic Patients Treated with Pelvic Bone Resection
by Edoardo Ipponi, Pier Luigi Ipponi, Fabrizia Gentili, Elena Bechini, Vittoria Bettarini, Paolo Domenico Parchi and Lorenzo Andreani
Cancers 2025, 17(16), 2629; https://doi.org/10.3390/cancers17162629 - 12 Aug 2025
Viewed by 1448
Abstract
Background: Pelvic resections represent some of the most challenging procedures in orthopedic oncology, often necessitating the sacrifice of large bone segments and, subsequently, the loss of nearby soft tissues. Our study aims to evaluate the impact of surgical resections of pelvic bone tumors [...] Read more.
Background: Pelvic resections represent some of the most challenging procedures in orthopedic oncology, often necessitating the sacrifice of large bone segments and, subsequently, the loss of nearby soft tissues. Our study aims to evaluate the impact of surgical resections of pelvic bone tumors on the performance of the pelvic floor and digestive, urinary, and genital systems. Methods: We evaluated all malignant or locally aggressive pelvic bone tumors treated with bone resection in our institution between January 2017 and January 2024. The reconstructive approaches were recorded. Pre- and post-operative MRI and CT scans were used to evaluate the grade of pelvic prolapse. The prolapse of the pelvic floor was assessed with the M-line, the H-line, and the anorectal angle. Hydronephrosis was also evaluated. Urinary and fecal incontinence were evaluated with the Pelvic Floor Impact Questionnaire (PFIQ7). Results: Thirty cases were included in our study. Nine cases were treated with custom-made prostheses, five had ice-cone prostheses, two massive allografts, and one composite allograft-prosthesis. The others had no bone reconstruction. Meshes were used to reconstruct the pelvic floor in 9 cases. Patients with discontinuity of the pelvic ring had a significantly higher grade of pelvic prolapse (M-line) and worse PFIQ7 scores. Conclusions: The resection of pelvic bone tumors represents one of the main challenges in orthopedic oncology. While planning surgical demolition and performing the subsequent reconstruction, surgeons should also consider the impact of the surgical treatment on the pelvic floor and surrounding organs. Intra-operative reconstructions and post-operative rehabilitation are advisable. Full article
(This article belongs to the Special Issue Sarcoma Management in Orthopaedic Oncology)
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Review

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17 pages, 3694 KB  
Review
Beyond the Signal: Imaging Insights and Diagnostic Relevance of Bone Oedema in Bone Tumours and Tumour-like Lesions
by Neel R. Raja, Hasaam Uldin, Ali Shah, Shashank Chapala and Rajesh Botchu
Cancers 2025, 17(13), 2074; https://doi.org/10.3390/cancers17132074 - 20 Jun 2025
Cited by 1 | Viewed by 2201
Abstract
Bone oedema is a non-specific imaging finding associated with a wide range of pathologies, including trauma, infection, inflammation, and neoplasms [...] Full article
(This article belongs to the Special Issue Sarcoma Management in Orthopaedic Oncology)
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Other

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15 pages, 794 KB  
Systematic Review
Rehabilitation Protocols and Functional Outcomes in Oncological Patients Treated with Modular Megaprosthesis: A Systematic Review
by Filip Fryderyk Brzeszczyński, Michał Karpiński, Marcel Aleksander Brzeszczyński, Oktawiusz Bończak and David F. Hamilton
Cancers 2025, 17(18), 2951; https://doi.org/10.3390/cancers17182951 - 9 Sep 2025
Cited by 2 | Viewed by 1260
Abstract
Background/Objectives: Bone reconstruction using megaprostheses is increasingly performed following bone tumour resections, including sarcomas, to enhance patient outcomes and quality of life. However, this is a complex patient group, and there is little consensus as to postoperative rehabilitation and associated outcomes. Methods: A [...] Read more.
Background/Objectives: Bone reconstruction using megaprostheses is increasingly performed following bone tumour resections, including sarcomas, to enhance patient outcomes and quality of life. However, this is a complex patient group, and there is little consensus as to postoperative rehabilitation and associated outcomes. Methods: A systematic search was conducted in MEDLINE and EMBASE databases according to the Implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidelines. Studies describing rehabilitation protocols and functional outcomes following bone tumour resection and modular oncologic megaprosthesis reconstruction were included. All papers were individually assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool. Results: The search generated 105 records, 28 underwent full-text review, and 13 studies were included. Available data reflect 371 patients with a mean age of 49.17 (S.D. 21.40) years and a mean postoperative follow-up of 41.88 (S.D. 32.88) months. Surgical indications were documented as sarcomas in 9 studies, and tumour metastasis to the bone in 10 studies. Rehabilitation protocols were reported in 5 studies following proximal humerus resection with a mean dislocation rate of 14.5% (S.D. 5.26). All protocols advised brace immobilisation for a period ranging between 10 days and 6 months. Superior Constant-Murley shoulder score was reported in patients with early active isometric exercises at 6 weeks. Six studies reported proximal femur prosthesis rehabilitation and functional outcomes, with a mean dislocation rate of 10% (S.D. 9.82). Enhanced outcomes were reported in studies employing early mobilisation. Two studies assessed distal femur prosthesis; both studies reported similar protocols with full weight bearing 3 weeks following surgery. The methodological quality of the studies varied, but was overall modest, with 10/13 studies meeting at least 50% of JBI reporting criteria. Conclusions: The existing literature on rehabilitation and outcomes in orthopaedic oncology patients following arthroplasty with megaprosthesis is limited, with rehabilitative protocols variably described. However, it seems that early active mobilisation does not increase the risk of joint dislocations or infections. Full article
(This article belongs to the Special Issue Sarcoma Management in Orthopaedic Oncology)
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