CORR® Tumor Board: Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study.

What are the surgical and research implications of this study? Megan E. Anderson MD Orthopaedic Oncology Surgeon Beth Israel Deaconess Medical Center and Boston Children’s Hospital Care for patients with bone sarcomas is inherently collaborative. Surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, physical therapists, social workers, basic scientists, biomedical engineers all bring their own expertise to the fold with the dual goals of beating the tumor and helping the patient to return to full function. There is no more perfect example of this than pelvic and sacral primary sarcomas. As noted by Bosma and colleagues [2], the most common sarcomas among adults in this location, chondrosarcoma and chordoma, do not respond well to systemic therapy [5]. Radiation generally has limited efficacy for bone sarcomas in all age groups, with the exception of Ewing sarcoma [4]. The bony pelvis and sacrum are such complex and important parts of the musculoskeletal system that reconstructive options require complicated biomedical engineering solutions. But these solutions have serious shortcomings, and so many patients will need extensive therapy, adaptive devices, and psychological support. Surgery remains the mainstay treatment for patients with pelvic and spinal sarcomas. In most patients with these diseases, other than those with Ewing sarcoma, if the tumor cannot be surgically removed in its entirety, the likelihood of a cure drops precipitously. Therefore, surgeons must collaborate with other specialists and incorporate technological advances with the goal of removing all of the tumor and preserving as much normal tissue as possible. Bosma and colleagues [2] investigate the application of computerassisted navigation to do just that. Their results demonstrate that resections performed with navigation were more likely to achieve adequate bonemargins than those performed without navigation. The authors appropriately caution readers about the importance of being familiar and facile with the technology, and they correctly point out that the image-to-patient registration (which orients the computer to the local anatomy, making precision resections possible) is the most-important step in the procedure. I agree wholeheartedly with the authors on both of those points. We can also think about these complex resections and the other ways in which using advanced technology A note from the Editor-in-Chief: We are pleased to present the next installment of our CORR Tumor Board column, which provides multidisciplinary perspective on the themes raised in selected CORR tumor papers. In this column, we will discuss the implications of the highlighted article from the varied disciplines of the Tumor Board members: Orthopaedic surgery, pathology, and radiology. This month’s column features the study “Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study” by Bosma and colleagues available at: DOI: 10.1097/CORR.0000000000000766. The authors certify that neither they, nor any members of their immediate families, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writers, anddonot reflect the opinionor policy ofCORR or TheAssociation of Bone and Joint Surgeons. Megan E. Anderson MD (✉), Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 USA, Email: manders6@bidmc.harvard. edu