Abstract
BACKGROUND: Osseous invasion in extremity soft-tissue sarcomas (STS) occurs in approximately 5-11% of cases and is associated with larger tumor size, higher histologic grade, deeper location, and increased risk of metastasis. Despite its relative rarity, bone invasion is a critical prognostic factor, presenting unique diagnostic and surgical challenges. PURPOSE: This review aimed to synthesize current evidence on the prevalence, diagnostic imaging, surgical management, and prognostic impact of osseous invasion in extremity STS and to offer evidence-based recommendations for clinical practice. METHODS: A comprehensive narrative review was conducted using structured searches of PubMed, Embase, and Cochrane Library, focusing on studies reporting original data on extremity STS with bone involvement. The key outcomes included diagnostic accuracy, surgical margins, functional recovery, and survival rates. RESULTS: Bone invasion significantly predicted poorer overall and disease-free survival, with 5-year survival rates of 27-40% compared to 60-70% in non-invasive cases. MRI remains the imaging modality of choice, although standardized radiological criteria for bone invasion are lacking. En-bloc resection provides reliable local control but carries substantial morbidity. Emerging bone-sparing techniques, such as subperiosteal and hemicortical resections, have demonstrated comparable oncologic outcomes with superior functional results in selected patients. CONCLUSIONS: Bone invasion in extremity STS represents a high-risk tumor subset that warrants individualized multidisciplinary management. While wide resection remains the standard treatment in cases with medullary involvement, selected patients may benefit from function-preserving approaches without compromising oncologic safety. Future research should focus on standardizing the diagnostic criteria, validating conservative surgical strategies, and refining multimodal treatment protocols to optimize outcomes.