Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor

Abstract

A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

Efficacy of Minimally Invasive Surgery on Giant Cell Tumour of the Bone: A Systematic Review

“…The axial bone group had a CT guided procedure to treat the GCT. In the long bones group, image intensifier was utilised for all 13 patients [5], [7]. Among them, 8 patients underwent the procedure with endoscope or osteoscope through a small incision, and the other 5 patients did not have additional visualisation inside the lesion [6], [8], [9].…”

“…Other specialised small surgical instruments can then insert through the trocars based on the type of surgery. Cryoablation method, for example, utilised 4 probes and the patient underwent minimum pain relieved by basic analgesic [5]. It is usually combined with the computer navigation system to navigate the limited visual field [6].…”

Percutaneous Treatments of Benign Bone Tumors

“…4 They typically appear between the ages of 20 and 40 and are often solitary lesions located in long bones, predominantly around the knees (50-65%). 31 GCT is a locally aggressive, usually benign (80%) neoplasia. However, recurrence after treatment may occur in 20 to 50%, with 10% becoming malignant on recurrence.…”

“…35 Radiotherapy is used in selected nonresectable cases that are unresponsive to drugs used for systemic therapy. 31 Percutaneous CT-guided cryoablation has been described as an alternative treatment option for a case of GCT with extensive pelvic bone involvement, including the acetabular region. 31 Due to the tumor location, encompassing the obturator foramen, and its wide local extension, a radical surgical approach was not an option.…”

“…31 Percutaneous CT-guided cryoablation has been described as an alternative treatment option for a case of GCT with extensive pelvic bone involvement, including the acetabular region. 31 Due to the tumor location, encompassing the obturator foramen, and its wide local extension, a radical surgical approach was not an option. After 1 year of medical treatment, denosumab stopped tumor growth, but there was no sign of local regression, leading to percutaneous cryoablation indication.…”