Role of adjuvant cryosurgery in intralesional treatment of sacral tumors

Abstract

BACKGROUNDCryosurgery is an adjuvant surgical technique for the treatment of benign aggressive, low‐grade malignant and metastatic tumors of long bones. It has been used rarely to treat sacral tumors, mainly because of potential damage to nerves, blood vessels, and intrapelvic organs. The authors described their experience with this procedure and provided medium and long‐term follow‐up results.METHODSFifteen procedures of cryosurgery of the sacrum were performed in 14 patients to improve the therapeutic outcome of a variety of tumors. The patient group included 7 males and 7 females with a mean age of 42 ± 24 years. Three patients were younger than 20 years of age. The procedures were performed at the Tel Aviv Sourasky Medical Center between January 1991 and January 1999. There were seven benign aggressive lesions (four giant cell tumors and three aneurysmal bone cysts), one benign schwannoma, one low‐grade chondrosarcoma, five metastatic carcinomas, and one high‐grade Ewing sarcoma, all localized at level S2 or higher. Eight of the bone tumors also involved significant anterior or posterior soft tissue. All patients had severe preoperative pain radiating to the buttocks, perineum, and lower limbs and 9 (64%) patients had bladder and/or rectal dysfunction. Invasive diagnostic procedures and radiation (if warranted) preceded surgery. Sacral posterior fenestration and burr drilling were followed by two‐cycle cryosurgery using the open pour technique or the argon‐helium–based heat‐freeze system.RESULTSAll interventions were performed under combined general and regional anesthesia and concluded uneventfully with moderate blood loss. Thirteen patients were discharged home after 8 ± 5 days (one patient remained hospitalized for 30 days). Only two patients experienced local disease recurrence during a 3–11‐year follow‐up period: one was retreated successfully by cryosurgery and the other underwent sacrectomy and radiotherapy elsewhere, with a subsequent loss of visceral functions. No patient suffered chronic pain, deep wound infections, or significant neurologic deficits and all were satisfied with the esthetic outcome.CONCLUSIONSCryosurgery is a conservative, feasible, and safe adjuvant technique in the treatment of sacral tumors. It is associated with minimal permanent neurologic and vascular injury compared with sacrectomy. Cancer 2003;97:2830–8. © 2003 American Cancer Society.DOI 10.1002/cncr.11383

Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function

“…The mean, median, and mode MSTS functional scores of the 39 subjects from whom MSTS scores were obtained were 27.2, 29, and 30, respectively, of 30 points (Fig. 3) (SD 4.8; range, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Management of metastatic sacral tumours

“…After screening, 16 studies were found to be eligible for inclusion (1 prospective cohort study on radiosurgery (level II) [32]; 2 case series (level III) [28,33]; 4 retrospective case series (level IV) [2,10,34,35] and 9 case reports (level IV) [36][37][38][39][40][41][42][43][44]; Table 1). …”

“…Six studies report on their results of surgery ranging from posterior decompression with(out) cementation and instrumentation [2,28,35,43] to abdominal sacral resection [33] and en bloc sacrectomy [34,44].…”

“…Spinal metastases develop in 5-10 % of all cancer patients during the course of their illness [2] with sacral deposits representing the minority of spinal secondaries [3]. Spinal metastatic infiltrations predominantly occur in the thoracic region, followed by the lumbar spine and the lumbosacral junction [4].…”

“…Breast, lung, renal, thyroid and prostate tumours form the predominant primary sources, less common primary lesions include lymphoma, melanoma and tumours of unknown origin [4][5][6][7][8]. Spread is mainly by haematogenic dissemination, although direct invasion through locally recurrent pelvic tumours is not uncommon [2]. Sacral metastases are relatively rare pathologies and their management constitutes a complex medical problem.…”