ABSTRACT
The classic staging system for primary tumours of bone is the Enneking system. Its greatest value is in the assessment of tumour spread: Blood vessels and the relationship of the tumour to the perivascular space are well defined, which aids greatly in preoperative assessment and the prediction of resection margins for limb-salvage surgery. In the case of a non-diagnostic needle biopsy or if a needle biopsy could place neurovascular structures at risk, an open biopsy may be considered. The key factor affecting the width of the margin is usually the closest critical structure commonly the neurovascular bundle. In recent years, a number of focused conventional radiotherapy strategies, including intensity-modulated radiotherapy, and non-conventional particle therapies have demonstrated promising results in the treatment of primary tumours particularly in unresectable regions, but also in the management of local recurrence.
