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Surgeries of pelvic bone tumors are very challenging due to the complexity of anatomical structures and the irregular bone shape. CT and MRI are used in clinic for tumor evaluation, each with its own advantages and shortcomings. Combining the data of both CT and MRI images would take advantage of the merits of both images and provide better model for preoperative evaluation. We utilized an artificial intelligence (AI)-assisted CT/MRI image fusion technique and built a personalized 3-D model for preoperative tumor margin assessment. A young female patient with pelvic osteosarcoma was evaluated with our novel image fusion 3-D model in comparison with the 3-D model based solely on CT images. The fusion image model showed more detailed anatomical information and discovered multiple emboli within veins which were previously neglected. The discovery of emboli implied abysmal prognosis and discouraged any attempts for complex reconstruction after tumor resection. Based on the experience with this pelvic osteosarcoma, we believe that our image fusion model can be very informative with bone tumors. Though further validation with a large number of clinical cases is required, we propose that our model has the potential to benefit the clinic in the preoperative evaluation of bone tumors.

Surgeries of pelvic bone tumors are very challenging due to the complexity of anatomical structures and the irregular bone shape. CT and MRI are used in clinic for tumor evaluation, each with its own advantages and shortcomings. Combining the data of both CT and MRI images would take advantage of the merits of both images and provide better model for preoperative evaluation. We utilized an artificial intelligence (AI)-assisted CT/MRI image fusion technique and built a personalized 3-D model for preoperative tumor margin assessment. A young female patient with pelvic osteosarcoma was evaluated with our novel image fusion 3-D model in comparison with the 3-D model based solely on CT images. The fusion image model showed more detailed anatomical information and discovered multiple emboli within veins which were previously neglected. The discovery of emboli implied abysmal prognosis and discouraged any attempts for complex reconstruction after tumor resection. Based on the experience with this pelvic osteosarcoma, we believe that our image fusion model can be very informative with bone tumors. Though further validation with a large number of clinical cases is required, we propose that our model has the potential to benefit the clinic in the preoperative evaluation of bone tumors. [ABSTRACT FROM AUTHOR]

We reviewed the surgical treatment and outcomes of 13 patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4 females with a mean age of 28.1 years. Four patients had ileal lesions, five had acetabulum lesions, one had a ischiopubis lesion, and three had involvement of the whole hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the amputation group. Local recurrence was higher in the limb salvage group. Overall survival was 18 months for mean follow up of 14.8 months. Median survival was 19 months in the limb salvage group compared to 9 months in amputation group. The outcome of surgical treatment of pelvic osteosarcoma remains poor despite advancements in musculoskeletal oncology treatment.

Simple Summary: Pelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remains unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had a larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma. Pelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remain unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma. [ABSTRACT FROM AUTHOR]