Long‐term follow‐up of patients with giant cell tumor of the sacrum treated with selective arterial embolization

Lin, Patrick P.; Guzel, Volkan B.; Moura, Marcio F.; Wallace, Sidney; Benjamin, Robert S.; Weber, Kristin L.; Morello, Frank A.; Gokaslan, Ziya L.; Yasko, Alan W.

doi:10.1002/cncr.10803

Cited by 140 publications

(91 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The clinical data of all patients are shown comprehensively (please see the Appendix) 9,[21][22][23][24][25][26][27] . For the location of lesions, 41 (93.2%) patients' lesions were detected in the sacrum, while only 4 patients' lesions (1 had GCTB of sacrum and pelvis) were found in the ilium.…”

Section: Description Of Patients' Clinical Featuresmentioning

confidence: 99%

“…Previous studies also reported that recurrence status was a potential negative prognostic factor for SAE. Lin et al revealed that 4 of 8 patients with recurrent disease died, compared to 1 of 10 with primary status who died 23 . Of the 44 patients, 13 cases were managed to measure and provide the tumor size precisely by the original authors in the articles.…”

Section: Assessments Of Embolizationmentioning

confidence: 99%

See 1 more Smart Citation

Selective Arterial Embolization for the Treatment of Sacral and Pelvic Giant Cell Tumor: A Systematic Review

Sun

et al. 2017

Orthopaedic Surgery

View full text Add to dashboard Cite

Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its limitations, especially for unresectable or recurrent tumors. Selective arterial embolization (SAE) is reported to be an option for treatment in several cases, but there are few systematic reviews on the effects of SAE on SGCT and/or PGCT. Medline and Embase databases were searched for eligible English articles. Inclusion and exclusion criteria were conducted before searching. All the clinical factors were measured by SPSS software, with P-values ≤0.05 considered statistically significant. A total of 9 articles were retrieved, including 44 patients receiving SAE ranging from 1 to 10 times. During the mean follow-up period of 85.8 months, the radiographic response rate was 81.8%, with a local control and overall survival rate of 75% and 81.8%, respectively. No bowel, bladder, or sexual dysfunction was observed. Three patients developed distant metastases and finally died. Patients with primary tumors tended to have better prognosis than those with recurrence (P = 0.039). The favorable outcomes of SAE suggest that it may be an alternative treatment for SGCT and PGCT patients for whom surgery is not appropriate.Key words: Local control; Overall survival; Pelvis; Sacral giant cell tumor; Selective arterial embolization Introduction G iant cell tumor of bone (GCTB) is defined as a potential locally aggressive tumor with a distant metastatic rate of approximately 6.6% [1][2][3][4][5][6] . It occurs most in the second to fourth decades of young adults, but also can be found in patients at any other period. Morbidities between men and women are almost equal. Epiphysis and metaphysis of long bones are the most prevalent sites among the GCT occurrence sites, especially at the distal femur and proximal tibia. Sacral giant cell tumor (SGCT) is the third most common GCTB. SGCT accounts for 2%-8% of all GCTB cases, while pelvic giant cell tumors (PGCT) are less frequent [7][8][9][10][11] . Pain is the most common complaint due to the osteolytic destruction. Other clinical manifestations include pathological fracture, losing control of bladder and bowel, as well as sexual dysfunction. Pathological fracture is generally considered as a potential predictor of higher local recurrence and distant metastases rate. GCTB are usually a solid brown mass. Histologically, they contain substantial multinucleated osteoclastlike giant cells and mononuclear stromal cells. According to their radiological appearance, GCTB are classified by Campanacci et al. 5 into three grades: Stage I, latent; Stage II, active; and Stage III, aggressive.Although surgery remains the treatment of choice for local SGCT, it is limited by a high recurrence rate and heavy surgical bleeding due to the complex anatomic structures, regardless of wide excision or intralesional curretage 8,12 . In addition, neurological dysfunction at the expense of incontinence and sexual dysfunction could lead to psychol...

show abstract

Section: Description Of Patients' Clinical Featuresmentioning

confidence: 99%

Section: Assessments Of Embolizationmentioning

confidence: 99%

Selective Arterial Embolization for the Treatment of Sacral and Pelvic Giant Cell Tumor: A Systematic Review

Sun

et al. 2017

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…Intralesional curettage is the mainstay of treatment in long bones and is often combined with local adjuvants such as cryotherapy, peroxide, ethanol, phenol, and bone cement to reduce recurrence. [61][62][63]77,78 However, due to the proximity of critical neurological structures, such adjuvants may not be appropriate or must be used only with care in the sacrum. Intralesional resection in the sacrum may potentially preserve neurological and other critical structures but present a greater risk of local recurrence, whereas wide excision may sacrifice neurological function to reduce recurrence.…”

Section: Surgical Pearlsmentioning

confidence: 99%

“…20 Histologically, GCTs are composed of stromal ovoid to spindle mononuclear cells with varying uniformity of multinucleated giant cells. 61 Sacral GCT often involves both sides of the midline, and extension across the sacroiliac joint is common. 19 …”

Section: Introductionmentioning

confidence: 99%

Image-guided resection of aggressive sacral tumors

Drazin¹,

Bhamb

Al-Khouja³

et al. 2017

FOC

View full text Add to dashboard Cite

OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience. Information, including background, imaging, treatment, and surgical pearls, is organized by tumor type. RESULTS Review of the institutional records identified 6 patients with sacral tumors who underwent surgery between 2009 and 2016. All 6 patients were treated with image-guided surgery using cone-beam CT technology (O-arm). The surgical technique used is described in detail, and 2 illustrative cases are presented. From the literature, the authors compiled information about chordomas, chondrosarcomas, giant cell tumors, and osteosarcomas and organized it by tumor type, providing a detailed discussion of background, imaging, and treatment as well as surgical pearls for each tumor type. CONCLUSIONS Aggressive sacral tumors can be an extremely difficult challenge for both the patient and the treating physician. The selected surgical intervention varies depending on the type of tumor, size, and location. Surgery can have profound risks including neural compression, lumbopelvic instability, and suboptimal oncological resection. Focusing on the operative nuances for each type can help prevent many of these complications. Anecdotal evidence is provided that utilization of image-guided surgery to aid in tumor resection at our institution has helped reduce blood loss and the local recurrence rate while preserving function in both malignant and aggressive benign tumors affecting the sacrum.

show abstract

“…Although SAE can reduce the recurrence rate of SGCT, high‐level evidence for the effectiveness of this method is lacking6, 24. Serial SAE as a stand‐alone treatment for SGCT is not a highly effective approach; it is usually used in inoperable SGCT24.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

Lin

Teng

et al. 2018

Orthopaedic Surgery

View full text Add to dashboard Cite

ObjectiveTo review the clinical details and further treatments for recurrent spinal giant cell tumors (SGCT), and to analyze the risk factors of recurrence and shed new light on the treatment options and prognosis of recurrent SGCT.MethodsA retrospective analysis of recurrent SGCT between April 2003 and January 2014 was performed. A total of 10 patients comprising 3 men and 7 women with a mean age of 28.9 years (range, 21–40 years) were included in the study. All complete clinical data, radiographs, CT, MRI, scans and pathological data were reviewed. The tumor locations and the regions involved were evaluated by CT and MRI. The blood supply of the tumors was evaluated by enhanced CT and MRI. The mean follow‐up was 81.3 months (range, 35.7–172.1 months).ResultsAll patients had Enneking stage 3 tumors; 9 (90%) of them had different extents of spinal canal involvement in the primary time period. All patients underwent intralesional resection during their first surgery. Only 1 patient received local adjuvant treatments; no patient underwent selective arterial embolization or used denosumab at that time. Only 1 patient underwent adjuvant radiotherapy postoperatively, and another patient used bisphosphonates. After recurrence, 1 patient was cured using denosumab, and 2 patients' disease was controlled through use of other medical treatments or adjuvant treatments. There were 3 repeated recurrences and 7 repeated surgical procedures were performed in 5 patients. There were 6 intralesional excisions and 1 decompression surgery. The mean relapse‐free time after the first surgery was 32.3 months (range, 10.5–62.6 months). The overall mean relapse‐free time was 40.2 months (range, 10.5–157 months). No distant metastasis was found in our series. At the final follow‐up, 4 patients were disease free, 3 patients' disease was under control, 2 has progressive disease aggravation, while 1 patient died as a result of progression of disease 133.9 months after first surgery.ConclusionIntralesional excision for recurrent spinal giant cell tumors is an effective option that may have satisfactory prognosis. However, the excision and the inactivation of the lesion should be carried out carefully and thoroughly without missing any corners. Early diagnosis of recurrence may be associated with better prognosis. Adjuvant treatments perioperatively and systemic medical treatments can decrease recurrence rates and can have therapeutic effects in the recurrent SGCT.

show abstract

Long‐term follow‐up of patients with giant cell tumor of the sacrum treated with selective arterial embolization

Cited by 140 publications

References 19 publications

Selective Arterial Embolization for the Treatment of Sacral and Pelvic Giant Cell Tumor: A Systematic Review

Selective Arterial Embolization for the Treatment of Sacral and Pelvic Giant Cell Tumor: A Systematic Review

Image-guided resection of aggressive sacral tumors

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

Contact Info

Product

Resources

About