Musculoskeletal OncologyGeneral Principles/General Principles

Tumor Board Decision Making   

Effective management requires: Radiological assessment Histopathological diagnosis Systemic therapy planning Functional reconstruction strategy Multidisciplinary tumor boards are central to: Accurate diagnosis Proper staging Individualized treatment decisions In bone and soft tissue sarcomas, key decisions such as: Biopsy planning Surgical margins Neoadjuvant therapy Reconstruction methods are determined through tumor board discussions.

Resident Dr. Faruk KARACA· Department of Orthopedics and Traumatology, Faculty of Medicine, Karadeniz Technical University
May 13, 2026

 1.Tumor boards provide:

  • Accurate and definitive decision-making through a multidisciplinary approach

  • Goal-directed and individualized treatment planning

  • Standardized selection of appropriate radiotherapy and chemotherapy protocols tailored to the patient

  • An evidence-based clinical decision-making process

2. Participants in the Tumor Board

  • Orthopedic oncologist

  • Musculoskeletal radiologist

  • Sarcoma pathologist

  • Medical oncologist

  • Radiation oncologist

  • Plastic surgeon

  • Nuclear medicine specialist

  • Interventional radiologist

  • Spine surgeon and/or vascular surgeon, when require

 

The members of the orthopedic oncology tumor board are presented in Table 1.

Table 1: Key members involved in the decision-making process of the orthopedic oncology tumor board.

 

3. Primary Objectives of the Tumor Board

  • Accurate diagnosis

  • Staging:
    Evaluation of surgical resectability, determination of the need for neoadjuvant or adjuvant therapy, and assessment of the feasibility of limb-salvage procedures.

  • Biopsy planning:
    Determination of the biopsy tract and selection of either closed or open biopsy techniques.

  • Surgical strategy:
    Achievement of negative surgical margins, prevention of local recurrence, preservation of function, and establishment of stable reconstruction.

  • Limb salvage versus amputation:
    Multidisciplinary assessment of the feasibility and expected outcomes of limb-salvage surgery.

  • Neoadjuvant and adjuvant treatment planning:
    Integration of medical and radiation oncologists into the treatment process.

  • Selection of reconstruction method

  • Management of complications

  

4. Factors Influencing the Decision-Making Process

  • Histological subtype

  • Tumor grade

  • Tumor size

  • Tumor localization

  • Relationship to neurovascular structures

  • Presence of skip metastases

  • Response to chemotherapy

  • Age

  • Performance status

  • Expected survival

  • Functional expectations

  • Comorbidities

  • Feasibility of achieving adequate surgical margins

  • Available reconstruction options

  • Risk of complications

 

5. Critical Tumor Board Decisions in Orthopedic Oncology

Biopsy Strategy

  • Tru-cut biopsy versus open biopsy

Limb Salvage versus Amputation

  • Determination of the feasibility and oncological safety of limb-salvage surgery

Neoadjuvant Chemotherapy and/or Radiotherapy

  • Assessment of indications for preoperative systemic therapy or radiotherapy

Pelvic Tumor Management Strategy

  • Selection of the most appropriate surgical and reconstructive approach for pelvic tumors

Decision for Spine Separation Surgery

  • Evaluation of the need for separation surgery in spinal tumors, particularly in the setting of epidural spinal cord compression

Surgical Indications in Metastatic Disease

  • Determination of surgical indications in patients with metastatic bone disease

 

6. Role of Imaging

  • Magnetic resonance imaging (MRI)

  • Computed tomography (CT)

  • Positron emission tomography–computed tomography (PET-CT)

  • Dynamic contrast-enhanced MRI

  • Evaluation of skip lesions

A musculoskeletal radiologist should be an essential member of the tumor board, and their interpretations should play a central role in the decision-making process.

7. Role of Pathology

  • Histological subtype

  • Tumor grade

  • Molecular markers

  • Limitations of frozen section analysis

  • Radiologic–pathologic correlation

 

8. Surgical Planning

  • En bloc resection

  • Surgical margin planning

  • Preservation of neurovascular structures

  • Extra-articular resection

  • Reconstruction algorithms

 

9. Impact of Tumor Boards on Survival and Clinical Outcomes

  • Improved local tumor control

  • Reduction in unnecessary surgical procedures

  • Decreased complication rates

  • More accurate biopsy planning and diagnosis

  • Improved functional outcomes

 

References:

1)    Siegel GW, Biermann JS, Chugh R, et al. The multidisciplinary management of bone and soft tissue sarcoma: an essential organizational framework. J Multidiscip Healthc. 2015;8:109-115. doi:10.2147/JMDH.S49805

2)    Pittarello C, Brunello A, Lamberti E, et al. Multidisciplinary approach to bone metastases: a single-center experience in a tertiary cancer center. Support Care Cancer. 2026;34(3):256. doi:10.1007/s00520-026-10476-6

3)    Wiesel SW, Albert TJ, Malawer MM, Wittig JC, Bickels J, editors. Operative Techniques in Orthopaedic Surgical Oncology. 3rd ed. Philadelphia, PA: Wolters Kluwer; 2023.

4)    Osman K, Ashford RU, Mangham DC, et al. A multidisciplinary team approach is highly effective in the management of nondiagnostic bone tumour biopsies: a 10-year retrospective review at a specialist sarcoma unit. Sarcoma. 2022;2022:7700365. doi:10.1155/2022/7700365

5)         Siegel GW, Biermann JS, editors. Orthopaedic Knowledge Update: Musculoskeletal Tumors 5. 5th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2020.

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