[Resection margins in bone tumors: what is adequate?]

Area of Science:

• Orthopedic Oncology
• Surgical Oncology
• Bone Sarcoma Research

Context:

• Multimodal therapy for bone sarcomas heavily relies on surgical resection.
• Preoperative imaging advances enable precise tumor boundary definition.
• Compartmental resections show no significant advantage over wide resections for local recurrence or survival.

Purpose:

• To review current literature and expert opinions on optimal surgical resection margins for bone sarcomas.
• To clarify the definition of "wide resection" in the context of bone sarcoma treatment.
• To provide evidence-based recommendations for achieving adequate surgical margins.

Summary:

• R0 resection is mandatory for osteosarcoma and Ewing's sarcoma; intralesional resection (R1) is acceptable for G1 chondrosarcoma.
• Adjuvant radiotherapy is recommended for osteosarcoma with R1 margins if re-resection is not feasible.
• For Ewing's sarcoma, radiotherapy alone is preferred over resection with contaminated margins, especially in critical locations like the pelvis.

Impact:

• Establishes that ultraradical resections do not improve outcomes and highlights the importance of margin quality over distance.
• Guides surgical decision-making for bone sarcomas, emphasizing tailored approaches based on tumor type and margin status.
• Informs treatment strategies by suggesting radiotherapy in specific scenarios to optimize patient survival and minimize recurrence.