Pelvic bone sarcomas (chondrosarcoma and ewing sarcoma) are among the rarest and most complex cancers to treat. Located deep within the pelvis and often close to major nerves, blood vessels and organs, these tumours require highly specialised surgery to remove them safely while preserving as much function as possible.
A new study from orthopaedic oncologists at the Royal Orthopaedic Hospital (ROH) highlights how the past two decades have shaped significant improvements in patient outcomes.
As part of the retrospective study, researchers reviewed every patient who underwent surgery for a primary pelvic bone sarcoma at the Royal Orthopaedic Hospital between 2003 and 2022. To understand how treatment has evolved, the 475 patients were divided into two groups: those treated between 2003 and 2012, and those treated between 2013 and 2022.
The increase in patients treated during the second decade reflects not only growing referrals to the specialist centre but also advances that have made surgery possible for patients who may previously have been considered inoperable.
The ROH has also become a national referral centre for these highly complex procedures, carrying out pelvic sarcoma surgery for patients across England as well as Northern Ireland and the Republic of Ireland.
Better Technology, Better Surgery
Over the past decade, several important innovations have transformed the way pelvic sarcomas are treated.
Computer-assisted surgical navigation and patient-specific planning are now used far more frequently, allowing surgeons to map tumour removal with greater precision. Prof Lee Jeys, Orthopaedic Oncology Consultant and paper author adds: “Ongoing research has also refined our understanding of the amount of healthy tissue that needs to be removed around a tumour to achieve the best balance between cancer control and preserving function.
We’ve also introduced bespoke 3D-printed pelvic implants through our partnership with ImplantCast. This means we’re able to create implants manufactured specifically for each patient and reconstruct the pelvis more accurately after tumour removal, ultimately supporting improved stability and recovery.”
Cleaner margins, lower risk of recurrence
One of the clearest signs of progress the study shed light on is in the improvement in surgical margins.
The proportion of patients with cancer cells remaining at the edge of the removed tissue—known as a positive margin—fell dramatically from 21% to just 8.5% over the study period. This means that more than nine out of ten patients undergoing surgery saw near-complete tumour removal with clear margins in the 2nd decade analysed.
Prof Jeys adds: “These improvements effectively translate into better local tumour control, with patients significantly less likely to experience their cancer returning at the original site.”
Improved survival and reduced complications
The study also demonstrated meaningful improvements in disease-specific survival for some tumour types.
Patients with chondrosarcoma experienced particularly encouraging results, with survival increasing by 30%, from 68% to 85%. Because chondrosarcoma does not respond to chemotherapy or radiotherapy, surgery is the mainstay of treatment for these patients, making advances in surgical precision especially important.
Alongside improved survival, the study also demonstrated broader improvements in patient care following surgery with return to theatre due to complications falling from 22% to 14% and hip dislocations reducing from 9% to 3%.
Prof Jeys comments: “Overall, patients required significantly fewer additional procedures to manage complications such as infection, wound breakdown and instability. Long-term reconstruction has also proven durable, with approximately 80% of implants remaining successful after 20 years, in large part due to the bespoke nature of these implants.”
The Importance of Specialist Centres
Pelvic sarcoma surgery is one of the most technically demanding procedures in orthopaedic oncology. These findings demonstrate the value of concentrating expertise within specialist centres, where multidisciplinary teams can combine surgical experience with advanced imaging, computer navigation and personalised implant technology.
The improvements seen over the past two decades are the result of continuous innovation, research and collaboration across surgical, engineering and oncology teams.
Prof Jeys concludes: “While the study demonstrates significant progress, it also highlights where further advances are needed. Outcomes for patients with osteosarcoma and Ewing sarcoma remain challenging, underlining the importance of developing new therapies and continuing research into both surgical techniques and systemic treatments.
“For patients diagnosed with pelvic bone sarcoma, however, the message is encouraging. Advances in technology, personalised surgical planning and specialist multidisciplinary care are leading to safer surgery, better local tumour control and improved survival, offering new hope for patients facing these rare and complex cancers.”
