Introduction: Giant cell tumor of bone (GCTB) is a benign but locally aggressive neoplasm with a recognized propensity for recurrence and occasional pulmonary metastasis. Diffuse involvement of an entire long bone is exceptionally rare. Case Report: A 29-year-old female with four previous surgeries for recurrent distal tibial giant cell tumor presented with extensive involvement of the entire tibia, talar extension, and pulmonary metastases. Histopathology and H3.3G34W immunostaining confirmed the diagnosis. Limb salvage reconstruction was not feasible and amputation was declined. Selective angioembolization followed by denosumab 120 mg monthly for 6 months resulted in significant clinical improvement and disease stabilization. At 24 months, the patient remained independently ambulatory with stable local and pulmonary disease. Conclusion: Combined angioembolization and denosumab may provide durable disease control and limb preservation in selected patients with extensive unresectable GCTB.

The goal in treating parosteal osteosarcoma is to achieve wide margins while minimizing morbidity. Marginal resections increase local recurrence (LR) risk. The impact of intramedullary involvement on outcomes remains unclear. We examined the role of quantitative margins and the effect of intramedullary involvement on LR and outcomes. We performed a retrospective analysis of 42 surgically treated parosteal osteosarcoma cases over 20 years (2000–2020) at a tertiary cancer centre. Final histopathology confirmed low-grade tumors in 39 cases and dedifferentiated in 3. Of 39 patients, 2 had amputations and 37 underwent limb salvage. Eight needed intra-operative vascular reconstruction. Quantitative margins were assessed in 25 primary cases with adequate follow-up: 10 had margins < 2 mm, 15 had ≥ 2 mm; 15 had margins < 5 mm, 10 had ≥ 5 mm. Among 37 patients with follow-up, 31 are alive and disease-free (22 continuously disease-free), while 6 have died (5 due to disease, 1 cardiac event). Median follow-up was 108 months (range 27–273). Ten patients had LR. Margins of ≤ 2 mm versus > 2 mm did not significantly influence outcomes, indicating that simply exceeding 2 mm was not associated with improved local control. However, a critical threshold effect was observed at ≥ 5 mm, as no patients with margins ≥ 5 mm developed local recurrence (LR). Three had isolated LR, seven combined relapses (LR + distant). Of these ten, five are alive and disease-free, four died of disease, one died of cardiac event. Intramedullary involvement did not affect LR (p = 0.69) but had a trend towards poor disease specific survival (DSS). The above findings underscore that achieving margins ≥ 5 mm represents a clinically meaningful cutoff, beyond which the risk of local or combined relapse is minimized, supporting ≥ 5 mm as the optimal target for oncologic resection margins. Intramedullary involvement and LR have a trend towards poor DSS.

Radiation therapy (RT) is a cornerstone in the treatment of solid tumours, with more than half of all cancer patients requiring it for curative or palliative intent. However, delays in initiating RT after CT simulation (CT sim) can significantly impact clinical outcomes by increasing recurrence risk, triggering re-simulation due to anatomical shifts and causing psychological and logistical distress for patients and caregivers. This prospective quality improvement (QI) study was conducted at a rural cancer center in India from April to December 2022, aiming to reduce the time from CT sim to RT initiation. Using the A3 methodology in collaboration with Enable Quality, Improve Patient Care India, Stanford Medicine and the National Cancer Grid, a root cause analysis was conducted, followed by key driver identification via Pareto analysis. A series of Plan-Do-Study-Act (PDSA) cycles led to targeted interventions, including written standard operating procedures (SOPs) for scheduling, standardised patient instructions, clearly defined staff roles and stakeholder education. Data from 200 patients planned for radical treatment were analysed weekly, with treatment timelines plotted on a run chart. At baseline, the median delay from simulation to treatment initiation was 18 days. After implementation of interventions in July 2022, this was reduced to 12 days by September and further to 10 days by November, a 44.4% reduction . Additionally, the re-simulation rate dropped from 10% to less than 1%. No patient experienced a delay beyond the prescribed date, and importantly, staff feedback confirmed that the revised workflow did not increase perceived workload. The interventions were institutionalised through SOPs and monitored via real time dashboards, ensuring sustainability into 2024. This study demonstrates that targeted, system-level interventions developed using accessible QI methodologies can lead to meaningful reductions in RT delays and operational inefficiencies in low-resource environments. The model is feasible, cost-effective and adaptable to other cancer centers aiming to optimise timely RT delivery and improve patient outcomes.

Aims:Surgical management of intermediate and malignant tumours in the pelvis is complex. Complications are frequent and either related to the surgery itself or to post-surgical failure of the reconstruction technique. This systematic review and meta-analysis aims at analyzing all reported complications following PI to PIII pelvic resections for intermediate and malignant tumours. Methods:Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis. Results:Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001). Conclusion:Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs.

Posterior reversible encephalopathy syndrome (PRES) in the postoperative period poses diagnostic and management challenges. Large pelvic soft-tissue tumors can cause substantial blood loss, requiring massive blood transfusion (MBT). We present a case of a 46-year-old male who underwent excision of a large pelvic ancient schwannoma, complicated by intraoperative massive blood loss of 8 L, necessitating transfusion of 9 units of packed red blood cells. The patient subsequently developed PRES in the postoperative period, as confirmed by MRI. The diagnosis and management of rare perioperative neurological complications such as PRES remain challenging. They require a high index of suspicion, vigilant clinical evaluation, prompt neuroimaging, and coordinated multidisciplinary care to enhance patient safety and outcomes.

Aims:The aim of this study was to achieve consensus on important topics related to tenosynovial giant cell tumour (TGCT) and giant cell tumour of bone (GCTB), and to identify areas for future research. Methods:In January 2026, a consensus meeting, The Birmingham Orthopaedic Oncology Meeting (BOOM), held in Cape Town, South Africa, gathered 314 delegates from 59 countries to debate 21 consensus statements on tenosynovial giant cell tumour (TGCT) and giant cell tumour of bone (GCTB) through a modified Delphi process. Results:Of the 21 statements, two achieved unanimous consensus, 18 strong consensus, and one moderate consensus. Unanimous consensus was reached for prioritizing joint-preserving intralesional curettage in GCTB when feasible, and for supporting non-surgical approaches in anatomically challenging cases, particularly sacral lesions. The statement addressing the role of denosumab in GCTB achieved only moderate consensus. The use of adjuvants in GCTB, as well as the management of recurrent and systemic GCTB, including long-term use of denosumab, reached strong consensus. Strong consensus was achieved in the surgical and non-surgical management for both primary and recurrent TGCT. Surveillance strategies for both TGCT and GCTB generated substantial discussion despite strong consensus, reflecting ongoing uncertainty and lack in evidence. Conclusion:This international consensus provides practical guidance for the management of TGCT and GCTB while identifying important gaps in evidence. Joint-preserving surgery remains central to the treatment of GCTB, with selective integration of systemic therapies and individualized surveillance. The consensus framework highlights priorities for future collaborative research in orthopaedic oncology.

BACKGROUND:Simultaneous reconstruction of extensive maxillary and mandibular defects in oncological cases is a complex surgical challenge. METHODS:We report a case of a 56-year-old female with synchronous oral malignancy involving upper and lower alveolus. Simultaneous double free fibula osteo-cutaneous flaps were used for reconstruction of upper and lower alveolus reconstruction. RESULT:We were able to circumvent this challenging case with the use of double fibular free flaps. The reconstruction successfully restored form, function, and aesthetics. CONCLUSION:This case describes the first reported use of double fibular flap for simultaneous upper and lower jaw reconstruction in a case of synchronous oral malignancy.

Objectives: Breast cancer (BC) is the most common cancer in women globally and in India. This study analyzes demographic characteristics, treatment patterns, and clinical outcomes of BC patients treated at two satellite centres in India during the first five operational years. Material and Methods: All eligible women patients with BC treated between 2015 and 2020 were included in this retrospective study. Factors impacting disease-free survival (DFS) and overall survival (OS) were identified using univariate analyses with Kaplan–Meier curves and multivariable Cox regression. Results: In total, 1267 patients with a median age of 52 years [early breast cancer (EBC), n = 704 (55.6%); locally advanced breast cancer (LABC), n = 563 (44.4%)] were included. 5-year DFS and OS rates were 79.1% and 82.9%, respectively (EBC, 86.6% and 88.3%; LABC, 68% and 72.8%, respectively). On multivariable analysis, mastectomy and hormone receptor (HR)-negative histology were significantly associated with inferior DFS for patients with EBC. For those with LABC, DFS was adversely impacted by HR-negative histology, nodal metastasis, and chemotherapy non-receipt. Conclusion: This study provides insight into contemporary BC treatment patterns and outcomes at two newly commissioned tertiary cancer care centres in India. These findings support the viability of a hub-and-spoke model for cancer care, suggesting that quality of care can be maintained while improving geographic access to treatment and informing future interventions.

Background: Despite multimodal treatment, oral cavity cancer (OCC) outcomes remain poor due to frequent presentation at advanced stages. Identifying reliable prognostic markers is crucial for improving outcomes. Lymphovascular invasion (LVI), perineural invasion (PNI), and depth of invasion (DOI) are key pathological features linked to aggressive tumor behavior. While each factor is associated with worse outcomes, their combined prognostic value remains underexplored. This study evaluates the combined prognostic value of LVI, PNI, and DOI on overall survival (OS) and recurrence-free survival (RFS) in OCC patients treated with curative intent. Methods: This retrospective study included 342 OCC cases treated from January 2017 to December 2021. Patients were stratified into six subgroups based on LVI (±), PNI (±), and DOI (> 1 cm or ≤ 1 cm). Survival outcomes were analyzed using Kaplan-Meier and log-rank tests. Independent prognostic factors were identified using Cox regression. A p-value < 0.05 was considered significant. Results: LVI, PNI, and DOI > 1 cm were present in 29.8%, 48.8%, and 43.3% of cases, respectively. Significant differences in OS and RFS were observed among the six subgroups. The worst outcomes were seen when all three risk factors were present, with a nearly fivefold higher risk of death. Shallower tumors (< 1 cm) were associated with improved survival, even in the presence of LVI or PNI. When both LVI and PNI were absent, OS and RFS differed significantly for deeper versus shallower tumours. Conclusion: Combined assessment of LVI, PNI, and DOI enables effective risk stratification in OCC and can guide forpersonalized patient treatment.

Oncological Total Knee Replacements(TKR) are complex surgeries compared to Conventional TKR’s as they involve morbid resections of bone and soft tissues with reconstructions. Literature on TKR for osteoarthritis, have reported around 10-34

Aims: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. Methods: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. Results: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). Conclusion: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.

Metaplastic breast carcinoma (MpBC) is a rare subtype of breast carcinoma characterized by mixed epithelial and mesenchymal differentiation and predominantly triple-negative phenotype. MpBC is associated with aggressive clinical behavior and poor response to standard chemotherapy. The extent to which MpBC demonstrates inferior survival compared with triple-negative invasive ductal carcinoma (TNBC-IDC), independent of clinical stage and treatment, remains unclear. We performed a retrospective cohort study of women with MpBC treated at a tertiary cancer center from 2016 to 2022. A comparison cohort of TNBC-IDC patients treated in the same period was identified. Propensity-score matching (PSM) at a 1:3 ratio was performed based on age, tumor size, nodal status, Ki-67, and receipt of neoadjuvant chemotherapy (NAC). Survival outcomes were estimated using Kaplan–Meier methods and adjusted Cox regression. Censoring occurred on 31 August 2025. Thirty-four MpBC patients were matched to 102 TNBC-IDC controls. MpBC showed larger primary tumors and no pathologic complete response to NAC (0

Purpose - Depth of invasion (DOI) and nodal stage are important prognostic factors of oral cavity cancer. Accurate determination of DOI depends on pathology assessment after surgery. We planned to assess correlation between radiological DOI (rDOI), pathological DOI (pDOI) and pathological nodal stage (pN). Methods - This is a retrospective analysis of 560 patients with oral cavity cancer treated with radical intent from January 2017 to December 2021. rDOI was measured by two radiologists independently and correlated with pDOI. Relation between DOI and nodal stage was investigated. Results - We observed very strong inter-reporter reliability for rDOI’s measured independently. rDOI significantly correlated with pDOI (Spearman’s rho = 0.916 and p-value<0.0001). Further, there was significant positive correlation between pDOI and pN (rho-0.337 and p<0.0001). Among patients with pDOI <1 cm, only 39% had nodal involvement, compared to 67% in the ≥1 cm group. Also, patients having pDOI >1cm had twice the incidence of pN3b. Conclusion - Measuring rDOI is feasible and comparable to pDOI and a predictor of pN stage and occult metastasis in clinically node negative patients. rDOI may be used as a reliable surrogate for planning nodal dissection in oral cavity cancer.

Introduction: Giant cell tumor (GCT) with chondroid differentiation is an uncommon entity. We report a case report of a 44-year-old female presenting with GCT of the left distal femur showing chondroid differentiation. Case Report: A 44-year-old female presented to us with complaints of pain and swelling in the left distal femur for 4 months. On further evaluation, X-ray revealed an osteolytic lesion in the distal femur with ill-defined margins and a narrow zone of transition. Magnetic resonance imaging showed a well-defined lesion in epi-metaphyseal lesion measuring 64 × 52 × 38 mm on the left side of distal femur, associated with a large soft tissue mass. Biopsy was done which revealed several fragments of cartilage with only a few fragments showing oval-to-spindle cell proliferation with areas of stromal hyalinization with some tumor fragments showing no unequivocal substantial number of osteoclast-like giant cells. Immunohistochemistry examination showed diffuse and strong nuclear positivity for H3.3G34W. Considering the diagnosis of GCT, the patient underwent curettage and cementing and plating. Final histopathology was also consistent with GCT, showing chondroid differentiation. The patient is 18-month post-surgery and is doing fine without any recurrence. Conclusion: This report details the radiological and pathological findings of the GCT of distal femur exhibiting cartilage matrix. It behaves as a GCT without cartilage matrix and should be treated accordingly. Furthermore, immunohistochemical staining with antibodies against the mutant-specific H3.3 protein or identification of H3.3G34A guides us for confirmation of diagnosis.

The Enhanced Recovery After Surgery (ERAS®) protocols are designed to maximize postoperative recovery and reduce complications. Despite extensive research on ERAS®, its implementation in bone and soft tissue surgeries is under investigated. The study aimed to assess the percentage compliance with individual components of the ERAS® pathway, determine the average overall compliance among patients, and compare postoperative complications across varying levels of compliance. In 300 patients with bone and soft tissue cancer surgeries from December 2021 to May 2023, we measured 20 ERAS® components for compliance including preoperative, perioperative, and postoperative items. We computed compliance percentages and postoperative results like postoperative length of stay, postoperative complications as per Clavien-Dindo (CD) class of complications, and readmission rates. The overall compliance rate with ERAS® protocols was 84.5

Aims:The aim of this study was to achieve consensus for important topics related to periprosthetic infection (PJI) in orthopaedic oncology, and to identify areas for future research. Methods:In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) held in Birmingham, UK, gathered 309 delegates from 53 countries to debate 20 consensus statements on PJI in orthopaedic oncology using a modified Delphi process. Results:Of 20 questions and statements on PJI in orthopaedic oncology, none achieved unanimous consensus, 18 achieved strong consensus, one achieved moderate consensus, and one achieved weak consensus. The statements that reached consensus with notable agreement were on the prophylaxis of infection, management of leaking wounds, and surgical strategies for the treatment of PJI. Short-duration antibiotic prophylaxis was deemed as effective as longer courses for lower-risk reconstructions, and aggressive management was recommended for wounds draining beyond five to seven days to prevent deep infection. Furthermore, single-stage, two-stage, and 1.5-stage revision were recognized as valid strategies, with two-stage revision remaining the most reliable. The statements that did not achieve consensus were on the role of debridement, antibiotics, and implant retention and prolonged antibiotic use post-revision. Conclusion:The BOOM meeting achieved consensus for important topics on periprosthetic infection in orthopaedic oncology, but highlighted the low quality of the underlying evidence. This study has provided recommendations for the treatment of leaky wounds, duration of postoperative antibiotic prophylaxis, and choice of revision strategy.

Ewing sarcoma is aggressive tumor with round cell morphology and very common in <15 years of age and young adults. Overall, incidence ranges from 10 to 15% of all the bone sarcomas. Ewing sarcoma most commonly affects lower extremity especially femur and other sites includes pelvis, upper extremity, and axial skeleton and ribs. The tumor cells are round blue cells on routine microscopy and the close differential includes other soft-tissue tumors such as primitive neuroectodermal tumor and neuroepithelioma. In addition to histology, the ancillary tests such as immunohistochemistry and cytogenetics studies are important for confirm diagnosis. Ewing sarcoma characteristically shows involvement of EWS gene located on chromosome 22q12. The most frequent translocation is EWS::FLI1 [t(11;22)(q24;q12) which appears approximately 85% of the cases followed by rare subtypes. Here, we report a case of young male who presented with fever, low backache, and weakness in lower limbs since 20 days. On CBC profile was normal and no significant past history; radiologically, there was mild-to-moderate compression fracture of L4 vertebral body with associated mild-to-moderate retropulsion of the posterior portion directly indenting and compressing the descending intrathecal nerve roots on both sides with small to moderate sized adjacent soft-tissue component. Diffuse alteration of marrow signal intensity involving cervical, dorsal, lumbar, and sacral vertebral bodies s/o? leukemia/lymphoma. Bone marrow and trephine biopsy suggested non hematopoietic malignancy. Cytogenetics studies showed aneuploidy (48,XY,+4,+8,t[9;22;21]); on that basis considered myeloid neoplasm with BCR:: ABL1 fusion. Which further on fluorescent in situ hybridization (FISH) considered negative. The final diagnosis was favored Ewing’ sarcoma based on the immunohistochemistry and cytogenetic translocation of chromosome 21 and 22. We report this case to highlight the importance of FISH as well as conventional karyotype for the additional chromosomal abnormalities in the Ewing’ sarcoma which, in isolation, leads to diagnostic dilemma.

Extranodal extension (ENE) and positive surgical margins are recognized high-risk factors in head and neck cancers. Despite their prognostic significance, ENE was incorporated into the AJCC 8th edition staging only recently. This study evaluates survival outcomes in patients with oral cavity squamous cell carcinoma (OCSCC) based on ENE status and its association with radiological ENE and other intermediate-risk features, including lymphovascular invasion (LVI), perineural invasion (PNI), T stage, and depth of infiltration (DoI). We retrospectively analyzed 198 patients with OCSCC treated between 2015 and 2022 with surgery followed by adjuvant radiotherapy (60 Gy in 30 fractions), with or without concurrent chemotherapy. Chemotherapy was administered in cases with ENE or margin positivity. Patients were followed at 3-month intervals with clinical evaluations and imaging as indicated. Kaplan–Meier analysis was used to estimate overall survival (OS) and disease-free survival (DFS). Differences between groups were assessed using the log-rank test, and univariate and multivariate Cox regression analyses identified prognostic factors. The mean age was 55 ± 12 years, with 86.4

Bone tumors are rare lesions that often pose diagnostic and therapeutic challenges for an orthopedic surgeon. Malignant bone lesions comprise <0.2 % of all cancers and the precise incidence of benign bone lesions is not documented. Many of these lesions appear cystic on imaging with varying number of overlapping features between benign lesions like Unicameral bone cyst, locally aggressive like Aneurysmal bone cyst, infections like hydatid cyst of bone to malignant like telangiectatic osteosarcoma. To aid the diagnosis, cystic bone lesions are classified into primary and secondary bone cysts. Primary bone cysts include simple bone cysts (SBC), aneurysmal bone cysts (ABC), epidermal inclusion cysts, intraosseous ganglion, intraosseous lipoma, and hydatid cysts of bone. Secondary bone cysts arise within a primary bone condition leading to cyst formation and include pathologies like fibrous dysplasia (FD), telangiectatic osteosarcoma, eosinophilic granuloma, Giant cell tumor (GCT) of bone and brown tumors. Each of these has peculiar diagnostic hallmarks, requires different treatment, and carries different prognosis. Due to their rarity and overlapping clinico-radiological features, cystic lesions often pose diagnostic and therapeutic dilemmas for clinicians and radiologists, often leading to errors in diagnosis and inadequate treatment which can endanger a patient's limb or life. Through this article, we aim to describe specific diagnostic hallmarks and treatment plans for these cystic bone lesions which can aid radiologists and treating orthopedic surgeons in diagnosing and manage these lesions optimally.