The February 2026 Oncology Roundup 360 looks at: Nearly half of sarcoma patients need a dedicated review; Caution when interpreting core need biopsy results of periacetabular chondrosarcoma; Outcomes of local therapies for recurrent and radiation-associated soft-tissue sarcomas of the limbs and trunk: is there a role for reirradiation?; Vacuum-assisted closure or primary closure for high-risk tumour resection wounds; High-level activity and access to sport following lower limb amputation due to malignant musculoskeletal tumours versus trauma: a prospective comparative study; Regional lymph node involvement in bone and soft-tissue tumours; 3D-printed and modular joint-preserving endoprosthesis around the knee; Take a “PERSARC” to improve decisions for patients with soft-tissue sarcomas.

Abstract Background Vascular anomalies constitute a heterogeneous spectrum of vascular tumors and vascular malformations that often mimic musculoskeletal neoplasms, particularly when presenting as soft tissue masses. Because conventional MRI may show nonspecific morphology, misclassification is common, and inappropriate biopsy may expose patients to significant bleeding risk. A multimodality imaging strategy incorporating Doppler ultrasound, CT angiography, and time-resolved MR angiography is therefore essential for accurate characterization. This case series reinforces four distinct diagnostic pitfalls and demonstrates how multimodal imaging systematically resolves each misinterpretation. Case presentation Four patients presenting with long-standing soft tissue masses underwent sequential multimodal evaluation after initial MRI findings suggested possible musculoskeletal tumors. In the first case, a 49-year-old woman with a paraspinal mass exhibited ill-defined, T2-hyperintense features that mimicked infiltration; only after CT angiography demonstrated a clear nidus with feeding intercostal arteries and early venous drainage was an arteriovenous malformation confirmed. The second case involved a 14-year-old girl with a forearm lesion showing restricted diffusion, a malignant-appearing dynamic contrast curve, and flow voids on SWI but histopathology revealed a benign vascular tumor, illustrating the limited specificity of functional MRI parameters. The third patient, an 18-year-old woman with a lobulated mass on the second digit, demonstrated well-defined but non-diagnostic MRI morphology; Doppler ultrasound subsequently confirmed internal vascularity and FNAB supported the diagnosis of hemangioma. The final case, a 12-year-old girl with extensive involvement of the calf, ankle, and foot, showed heterogeneous enhancement that simulated malignant infiltration; TRICKS-MRA revealed slow delayed filling consistent with a low-flow malformation, and biopsy confirmed lymphangioma. Across all cases, diagnostic errors were consistently linked to inadequate assessment of vascular flow dynamics. Conclusion Vascular anomalies may closely resemble soft tissue malignancies when assessed with MRI alone. Dynamic and physiologic imaging provides decisive information on flow patterns and vascular architecture, enabling accurate classification and reducing unnecessary biopsy. A standardized, multimodal diagnostic algorithm is essential when evaluating soft tissue masses with atypical or ambiguous MRI features.

Interventional oncology has gained a lot of traction as an attractive alternative treatment for various musculoskeletal tumors by offering minimally invasive image-guided therapies. In this domain, thermal ablation is increasingly being used malignant tumors, including bone metastatic disease. Thermal ablation therapies such as radiofrequency ablation, microwave ablation, cryoablation and high intensity focused ultrasound therapy achieve excellent local tumor control and pain palliation, whilst structural stability is ensured through the combination with bone augmentation techniques such as standard or reinforced osteoplasty. Many factors are affecting the results including the biology of the disease the treatment intent (curative or palliative) as well as the potential for complications, like thermal injury to surrounding tissues, highlight the need for meticulous procedural planning. This review highlights the pathophysiology, the current repertoire of thermal ablation techniques, clinical outcomes and the future directions for the treatment of metastatic bone disease.

Backgtound. Replacement of large bone defects after tumor resection is a significant challenge. The use of autologous tissue is often limited due to the small volume of available autograft bone and additional surgical trauma. Although many biological and synthetic substitutes exist, there is still no consensus on the optimal choice. Recost, a new domestic synthetic bone substitute material, introduced in 2014, is a promising alternative for reconstructive surgery. the purpose of the study was to analyze outcomes of using “Rekost”, the bone substitute material, in surgical treatment of bone tumors. Material and Methods . Between 2016 and 2022, 23 patients with bone tumors were treated at the oncology department of the E. Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation. The study included patients over 18 years of age with benign and tumor-like bone neoplasms (11/23, 47.8 %), as well as patients with borderline bone tumors (11/23, 47.8 %), who underwent surgery with the simultaneous use of Recost, a new bone-substituting material. One patient had osteosarcoma (1/23, 4.3 %). Most patients (20/23, 86.9 %) underwent bone tumor resection followed by reconstruction with “Rekost” bone-replacing material. Results. All patients are alive with follow-up periods ranging from 30 to 113 months (mean 62 ± 7). Early postoperative pain, assessed by the Visual Analog Scale (VAS), ranged from 10 % to 50 %, averaging 20 ± 10 %. At 12 months postoperatively, most patients were free of pain (0–20 %). Functional outcomes measured by the Musculoskeletal Tumor Society (MSTS) score were rated as excellent or good on follow-up: upper limb MSTS scores ranged from 73 to 97 %, mean 89 ± 10 %; lower limb MSTS scores ranged from 57 % to 100 %, mean 81 ± 14 %. No intraoperative, early postoperative, or systemic complications related to the use of “Rekost” material were observed. Late local complications occurred in two cases (2/23; 8.6 %) at 6 and 9 months postoperatively. Among patients with borderline tumors, one patient (1/11, 9 %) developed giant cell tumor recurrence nine months after resection of the distal radius. One-and two-year recurrence-free survival rates in this subgroup of patients were 92 %, respectively. Conclusion. Preliminary use of the “Rekost”, domestic bone substitute demonstrates a low rate of complications and re-surgeries. This material may be recommended for reconstructing defects after tumor resections in patients with benign and borderline bone tumors. However, the physical and chemical properties of the material require further study and comparative analysis with traditional reconstruction methods.

Giant cell tumor of bone (GCTB) occurring in the femoral head and neck region presents significant therapeutic challenges due to its complex anatomy and aggressive biological behavior. This study aimed to analyse the clinical outcomes of preoperative denosumab therapy combined with curettage after surgical dislocation of the hip in the treatment of GCTB at the femoral head and neck region. Between 2016 and 2023, a total of 16 patients with GCTB in the femoral head and neck were treated at the authors' institution, of whom 14 eligible and included in the study (6 males/8 females, aged 17-35 years). All patients received three cycles of Denosumab therapy preoperatively, with treatment response monitored and therapeutic efficacy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Subsequently, surgical dislocation of the hip combined with curettage of the lesion was performed. Regular postoperative follow-up was conducted to monitor for complications. Imaging studies were used performed to evaluate surgical site status, local recurrence, and distant metastasis. Limb function and hip joint function were assessed preoperatively and at 1 year postoperatively using the Musculoskeletal Tumor Society (MSTS) score and Harris Hip Score (HHS), respectively. All 14 patients underwent a full course of preoperative denosumab therapy and underwent successful surgery, with a follow-up period of 24-50 months (mean 38.2 ± 9.0 months). No postoperative complications observed. Imaging revealed shrinkage of residual cavities, blurred boundaries, progressive bone sclerosis, and trabecular bone regeneration at the surgical site. Functional assessments demonstrated significant improvements in MSTS scores (preoperative: 22.3 ± 1.3 compared with postoperative: 27.6 ± 1.2, P <0.001) and HHS (preoperative: 72.4 ± 3.1 compared with postoperative: 88.9 ± 4.3, P <0.001). All patients achieved excellent functional status (MSTS >25, HHS >82) with preserved joint mechanics. Preoperative denosumab therapy achieved partial remission (PR) in 79% (11/14) and stable disease (SD) in 21% (3/14) patients according to RECIST 1.1 criteria. At final follow-up, no patients experienced local recurrence or metastatic progression. Denosumab treatment combined with curettage after surgical dislocation of the hip successfully treated GCTB in the femoral head and neck. The safety profile of denosumab as adjuvant therapy was favorable, with no drug-related complications observed. Postoperatively, native hip joints were preserved in all patients, with satisfactory functional outcomes and no evidence of tumor recurrence or metastasis.

To evaluate the performance and technical parameters of whole body (WB)-MRI for staging and follow-up of primary musculoskeletal tumors. A systematic review was done in PubMed and Embase through July 2025. Eligible studies reported WB-MRI for staging or follow-up of bone/soft tissue sarcomas. Extracted data were study design, patient characteristics, MRI protocols, scan duration and diagnostic performance. Methodological quality was assessed with QualSyst. A total of 10 studies, published between 2016 and 2024, were included from 432 records. Most were retrospective (90%), with study populations ranging from 9 to 319 patients (total n = 790, age range 2-80 years). Half of the studies focused on myxoid liposarcoma, while others addressed osteosarcoma, Ewing sarcoma and chondrosarcoma. WB-MRI protocols employed 1.5T and/or 3T scanners. Non-contrast protocols (8/10 studies) mostly included T1 and STIR sequences. Exam durations ranged from 30 to 78 minutes, with outliers up to 250 minutes. Reference standards included CT, PET-CT and bone scintigraphy. Diagnostic accuracy was investigated in only two studies, reporting 100% sensitivity, 96.3% specificity, and 97.3% accuracy for extrapulmonary metastases, 83%-88% sensitivity and 94%-95% specificity for bone metastases. The studies demonstrated high methodological rigor, with scores ranging from 16 to 19 out of 20. : WB-MRI is a feasible and promising modality for staging and follow-up of primary musculoskeletal tumors. Evidence is still limited, based on heterogeneous and mostly retrospective studies. Larger, prospective, and standardized studies are needed to validate its accuracy, optimize imaging protocols and clarify its role in sarcoma imaging.

Background: Atypical cartilaginous tumors (ACT), formerly classified as Grade 1 chondrosarcomas (CS1) of the extremities, are hyaline cartilage-producing neoplasms. The WHO classification (4th edition, 2013) redefined ACT as locally aggressive rather than malignant tumors, prompting a shift toward less aggressive surgical management. This study reports data of a single, tertiary musculoskeletal tumor center and compares the long-term oncological outcomes of wide resections and intralesional curettage for primary ACT. Methods: This retrospective study included 61 patients with ACT treated at a tertiary tumor center between 2003 and 2023. Patients were divided into two cohorts: Cohort 1 was treated before 2013 with wide or radical resection, while cohort 2 was treated with an intralesional approach. Data on recurrence, revision rates, survival, and predictors of outcomes were analyzed using Kaplan-Meier survival analysis and log-rank testing. Results: Wide resections were performed in 24 patients, requiring prosthetic reconstruction in 76% of cases. Intralesional curettage was performed in 37 patients. Local recurrence occurred in 8% in wide resections versus 16% of curettage cases (p = 0.198), with no significant difference in time to recurrence between cohorts. Unplanned revision rates were higher in the wide resection group (42%) compared to curettage (35%), driven primarily by prosthesis-related complications. Overall survival was high in both groups (88% in wide resections vs. 94% in curettage; p = 0.705). Resection margins, and metastases were identified as significant predictors of both recurrence and tumor-related death. Conclusions: Intralesional curettage provides comparable oncological outcomes to wide resections with reduced morbidity, supporting its use as the preferred treatment for ACT in appropriately selected patients.

Patellar Height and Functional Outcomes after Distal Femoral Replacement: Higher Patella Improves Flexion, While Patella Baja Predicts Worse Outcomes.

Functional outcomes and complications of elbow endoprosthesis reconstruction after tumor resection: insights from a national study at two sarcoma centers.

A high rate of hip subluxation has previously been reported after implantation of a proximal femoral megaprosthesis in children. The primary aim of this retrospective study was to compare the incidence of acetabular dysplasia and hip subluxation, and the functional outcome and revision-free survival between children with open and closed triradiate physes at the time of implantation of their prostheses. All patients were aged < 18 years and had a reconstruction with a non-extendable proximal femoral megaprosthesis. Extra-articular resections involving the acetabulum were excluded. Patients were classified into two groups: Group A with an open and Group B with a closed triradiate physis at the time of limb salvage surgery. A total of 36 patients were included; 15 in Group A and 21 in Group B. Their mean age at the time of surgery was nine years (2 to 13; SD 3.14) in Group A and 14 years (12 to 17; SD 1.57) in Group B, with a median follow-up duration of 103 months (IQR 54 to 110) and 58 months (IQR 38 to 106), respectively. Modes of failure and functional outcome were described using the modified Henderson classification and Musculoskeletal Tumor Society score, respectively. The two groups were compared using the Mann-Whitney U and chi-squared tests. The five-year revision-free survival was estimated using Kaplan-Meier and compared between groups using the log-rank test. Limb length inequality, hip subluxation, and acetabular dysplasia were significantly higher in Group A (p < 0.001, p = 0.032, and p = 0.007, respectively). There were no significant differences in functional outcome, revision-free survival, or time-to-resurfacing between groups (p = 0.076, p = 0.469, and p = 0.587, respectively). Functional outcome and revision-free survival of proximal femoral megaprosthesis in children with an open triradiate physis are no different from those with closed physes, despite the high rate of acetabular dysplasia and hip subluxation.

Total excision of the femur and its reconstruction pose a substantial challenge in children. We present the long-term results of total femoral excision and type BIIIa rotationplasty in children. A total of 18 patients who had undergone a type BIIIa rotationplasty over a period of 20 years were included in the study. Their mean age at the time of surgery was 7.1 years (3.3 to 11). Two patients underwent a hip disarticulation in the perioperative period. Five died in the first two years from surgery. The mean follow-up of the remaining 11 patients was 124 months (24 to 244). We evaluated their long-term radiological, functional, and oncological outcomes and measured any limb length discrepancy at final follow-up. The hip was stable in eight of 11 patients. Radiologically appreciable remodelling of the proximal tibia was seen in all patients. At final follow-up, four patients had reached skeletal maturity, five were adolescents (aged 12 to 17 years), and two were still pre-adolescent (aged < 12 years). The mean shortening in the skeletally mature patients was 2.25 cm (0 to 4). Limb length was measured in four of the five adolescent patients: the mean shortening was 0 cm (-1 to +1). Other than the two patients who underwent a hip disarticulation in the immediate perioperative period, no patient needed a subsequent surgical procedure. None of the patients had a local recurrence. The five-year probability of overall survival was 70% (95% CI 51 to 96). The mean Musculoskeletal Tumor Society score was 23 (22 to 23). The mean Toronto Extremity Salvage Score calculated in nine patients was 91 (82 to 100). A type BIIIa rotationplasty is a reliable option for reconstruction after total femoral excision in children. Long-term follow-up shows good functional and oncological outcomes, without the need for additional surgical procedures.

Objective:The aim of this study was to evaluate the epidemiological features, anatomical distribution, and treatment methods of bone and soft tissue tumors in the foot and ankle region.Methods:This retrospective study included 193 cases evaluated at the musculoskeletal tumor board of the institution between January 2014 and December 2024. Patients’ demographic data (84 males, 109 females; mean age, 37.8 years), lesion type, anatomical location, histopathological subtype, and treatment modalities were recorded. Tumors were classified according to the 2020 World Health Organization classification of bone and soft tissue tumors.Results:Of the 193 cases, 128 (66.3%) were true tumors and 65 (33.7%) were tumor-like lesions. Among the tumors, 70 (54.7%) were bone tumors, 54 (42.2%) were soft tissue tumors, and 4 (3.1%) were metastases. Benign lesions accounted for 79.7%, malignant for 14.0%, and intermediate for 6.3% of all tumors. Tumors were most frequently located in the forefoot (44%), followed by the ankle (29%). Intraosseous lipoma was the most common benign bone tumor, giant cell tumor of the tendon sheath the most common benign soft tissue tumor, and ganglion cyst the most frequent tumor-like lesion. Excisional biopsy was the main treatment, whereas amputation was mainly performed for malignant tumors.Conclusion:Foot and ankle tumors are rare but clinically significant as misdiagnosis or delayed diagnosis can lead to poor outcomes. Although most are benign, malignant cases, especially in the ankle region, require aggressive management. Awareness of their regional distribution and histopathological spectrum is essential for early recognition, accurate diagnosis, and appropriate treatment planning.Level of Evidence:Level IV, Diagnostic study.

Pelvic reconstruction following bone sarcoma resection presents significant challenges. This study evaluates the outcomes of using 3D-printed custom-made prostheses and cutting guides to improve surgical precision and functional results in periacetabular reconstructions. Therefore, in this study, we asked: (1) What is the cumulative incidence of reoperation for any reason following pelvic resection and reconstruction with a custom-made 3D-printed prosthesis involving the acetabulum in patients with primary bone sarcoma, and what factors contribute to an increased risk of reconstruction failure? (2) Does the use of 3D custom-made cutting guides, combined with a 3D custom-made hemipelvis prosthesis, ensure the attainment of safe resection margins and allow for anatomical reconstruction with optimal fit at the bone-prosthesis interface? (3) What were the observed outcome scores as measured by the Musculoskeletal Tumor Society (MSTS) Score? Additionally, how do the type of resection and the volume of the primary bone sarcoma affect the outcomes in relation to the type of reconstruction? We conducted a retrospective review of 24 patients treated for primary bone sarcomas at our institution from January 2013 to December 2023. Each patient received a 3D-printed cutting guide and a 3D-printed custom-made prosthesis tailored to their specific anatomical needs, based on high-resolution imaging and computer-aided design. The use of custom-made 3D prostheses resulted in a reoperation rate of 46%, primarily due to complications such as infection and mechanical failures. Specific complications included an 8% rate of deep infections and mechanical issues like aseptic loosening. Local recurrence was observed in 5 patients (21%) at a median time of 5 months post-surgery. Despite these challenges, the average MSTS score was 83.7%, indicating a high level of functional recovery post-surgery. The integration of 3D printing in pelvic reconstructions for bone sarcomas significantly enhances anatomical and functional outcomes. However, the technology demands further refinement to reduce complication rates. Continued advancements in 3D-printing materials and techniques are crucial to maximizing the benefits of this innovative approach in orthopedic oncology.

Advances in orthopedic oncology have significantly improved outcomes following extremity tumor resections; however, complications like nonunion, hardware failure, and radiation-induced fractures can occur after orthopedic fixation. While the vascularized fibula-free flap (FFF) is well-established in primary reconstructions, its effectiveness as a salvage option is not well described. We report our 25-year experience with the use of FFF in salvage extremity reconstruction. This retrospective case series included patients undergoing extremity salvage with FFF after failure of primary oncologic reconstructions from 1995 to 2021. Demographics, surgical indications, reconstructive details, functional outcomes, complications, and Musculoskeletal Tumor Society (MSTS) scores were analyzed. Fifteen patients (ages 6-71 years) met inclusion criteria, which included nine humeral and six femoral reconstructions, with an average follow-up of 6.7 years. Indications for salvage were radiation-induced fracture (n = 6), nonunion (n = 3), allograft fracture (n = 3), and hardware failure (n = 3). The median interval between the initial surgery for tumor resection and FFF for limb salvage was 4 years 3 months (mean: 9 years, range: 10 months to 29.3 years). All lower-extremity reconstructions achieved full weight-bearing without pain. Upper-extremity reconstructions resulted in full functional restoration in six patients and minor functional deficits in three. Bony union of fibula flap was achieved in 78.5% patients. Reoperation were performed in 4 patients for wound issues (n = 2) and hardware removal (n = 2). FFF is a reliable and effective option for management of oncologic-related complications of the extremities. It can avoid amputations and improve limb function.

Objectives: The use of chemical shift imaging (CSI) for characterizing localized and diffuse bone marrow lesions is well established. However, the CSI characteristics of soft-tissue musculoskeletal tumors have not yet been established. The aim of this study is to describe the CSI features of soft-tissue tumors and establish their potential clinical usefulness. Material and Methods: Magnetic resonance imaging with CSI of eighty histopathologically proven musculoskeletal soft tissue tumors was retrospectively assessed. In-phase and out-of-phase signal intensity was measured to calculate the percentage reduction in signal (drop-out). Signal drop-out was correlated with histopathological diagnosis. Results: Based on the histopathological diagnosis, 80 patients in our study were grouped in 5 cohorts comprising lipomatous, lipomatous variant, neural, myxoid, and other soft tissue tumors. The mean signal drop was highest in the lipoma variant cohort (−27.4 ± 18.5%), followed by the lipoma cohort (−12.4 ± 5.9%), the neural tumors cohort (−2.7 ± 5.2%), the myxoid tumors cohort (−1.9 ± 5.2%), and the other soft tissue tumor cohort (0.8±18.3%). The difference was statistically significant ( P &lt; 0.001). Signal dropout demonstrated good ability to identify lipoma variants with an area-under-the curve of 0.85 (95% confidence interval [CI] = 0.69–0.99). There was excellent intra-observer reliability (intra-class co-efficient [ICC] = 0.996, 95% C.I. 0.990–0.998) and inter-observer reliability (ICC 0.990, 95% C.I. 0.971–0.996). Conclusion: Lipoma variants demonstrate increased signal dropout compared to other soft-tissue tumors; CSI shows promise in augmenting the diagnostic pathway in the evaluation of soft tissue tumors.

Background: Vision-language models show promise in medical image interpretation, but their performance in musculoskeletal tumor diagnostics remains underexplored. Objective: To evaluate the diagnostic accuracy of six large language models on orthopedic radiographs for tumor detection, classification, anatomical localization, and X-ray view interpretation, and to assess the impact of demographic context and self-reported certainty. Methods: We retrospectively evaluated six VLMs on 3746 expert-annotated orthopedic radiographs from the Bone Tumor X-ray Radiograph dataset. Each image was analyzed by all models with and without patient age and sex using a standardized prompting scheme across four predefined tasks. Results: Over 48,000 predictions were analyzed. Tumor detection accuracy ranged from 59.9–73.5%, with the Gemini Ensemble achieving the highest F1 score (0.723) and recall (0.822). Benign/malignant classification reached up to 85.2% accuracy; tumor type identification 24.6–55.7%; body region identification 97.4%; and view classification 82.8%. Demographic data improved tumor detection accuracy (+1.8%, p &lt; 0.001) but had no significant effect on other tasks. Certainty scores were weakly correlated with correctness, with Gemini Pro highest (r = 0.089). Conclusion: VLMs show strong potential for basic musculoskeletal radiograph interpretation without task-specific training but remain less accurate than specialized deep learning models for complex classification. Limited calibration, interpretability, and contextual reasoning must be addressed before clinical use. This is the first systematic assessment of image-based diagnosis and self-assessment in LLMs using a real-world radiology dataset.

Objectives: The objective of the study is to compare the bipolar hemiarthroplasty (BHA) and total hip modular prosthesis total hip arthroplasty (THA) regarding functional outcomes, dislocation rate, and detection of the rate of acetabular erosion for the BHA. Methods: A comprehensive retrospective cohort comparative study was conducted on patients aged between 15 and 65 years, who underwent wide resection and reconstruction by proximal femoral modular prosthesis for a primary bone tumor, either with THA (21 patients) or BHA (33 patients), from January 2017 to October 2020, and with a minimum follow-up of 1 year. Results: The 1-year Musculoskeletal Tumor Society score was statistically significantly better in the THA group (26.32 points), compared to the BHA group (24.10 points) ( P : 0.007). The 1-year Harris Hip Score was 90.53 points in the THA group, and 87.55 points in the BHA ( P : 0.032). No statistically significant difference was found regarding dislocation incidence and infection between the two groups ( P : 1.000 and 0.386, respectively). The acetabular erosion rate for the BHA was 27.3% with a mean post-operative time of 81.50 months. Conclusion: The study suggests better functional outcomes in the THA group compared to the BHA group, with no significant difference in dislocation or infection rates. The higher acetabular erosion in the BHA group suggests that, for young patients with a primary bone tumor, a THA may provide better functional outcomes.

MR cytometry: More effective than conventional diffusion MRI in differentiating benign and malignant musculoskeletal tumors.

Soft-Tissue Tumor Reporting and Data System (ST-RADS): Prospective implementation and diagnostic accuracy.

Non-neoplastic Orthopedic Pathology Updates: Common Problems and Pitfalls and How to Avoid Them.