Intermediate-grade vascular neoplasms of the bone are rare and clinically challenging entities. Traditional management often involves wide surgical resections or even amputation, both of which can significantly impair function and quality of life. In our case report (recently selected as the Editor’s Choice for May in the Journal of Radiotherapy in Practice) we explored a function-preserving, oncologically safe alternative: extracorporeal radiotherapy (ECRT).

The case involves a 28-year-old male patient presenting with claudication and a destructive lytic lesion (65 × 40 × 91 mm) in the distal diaphysis of the right femur. Imaging confirmed malignancy without metastasis. We surgically excised the affected bone segment and subjected it to a single 50 Gy dose of radiotherapy outside the body using a Varian Trilogy linear accelerator. After irradiation, the bone was reimplanted and internally fixed with plate and screws.

Histopathological analysis confirmed an intermediate-grade vascular neoplasm with no angioinvasion or perineural spread. Immunohistochemistry supported the diagnosis with positivity for Pansitokeratin, Vimentin, Cytokeratin-7, D2-40, and CD31. The patient experienced an uneventful recovery, and during 30 months of follow-up, we observed no recurrence, metastasis, or significant complications. Functional outcomes were excellent, with no movement restrictions or late side effects.

This case highlights how ECRT, when applied with precise imaging, tailored treatment planning, and interdisciplinary cooperation, can offer curative treatment without sacrificing limb function. It demonstrates that high-dose radiation delivered extracorporeally can effectively sterilize tumour-bearing bone while preserving its biomechanical integrity.

We believe that with further standardization and refinement, ECRT can become a mainstream limb-salvage strategy for selected patients with bone tumours. We hope this case encourages clinicians and researchers to consider this promising method, particularly for young, active patients who demand both survival and quality of life.

The paper ‘Experience with extracorporeal radiotherapy in intermediate-grade vascular neoplasm of bone tumour: a case report‘, is available as part of the Journal of Radiotherapy in Practice Editors’ Choice collection.