Treatment and outcome of giant cell tumors of the pelvis

Abstract

Background and purpose Giant cell tumors (GCTs) of bone rarely affect the pelvis. We report on 20 cases that have been treated at our institution during the last 20 years.Methods 20 patients with histologically benign GCT of the pelvis were included in this study. 9 tumors were primarily located in the iliosacral area, 6 in the acetabular area, and 5 in the ischiopubic area. 8 patients were treated by intralesional curettage and 6 by intralesional resection with additional curettage of the margins. 3 patients with iliacal tumors were treated by wide resection. 2 patients were treated by a combination of external beam irradiation and surgery, and 1 patient solely by irradiation. In addition, 9 patients received selective arterial embolization one day before surgery. Of the 6 patients with acetabular tumors, 1 secondarily received an endoprosthesis and 1 was primarily treated by hip transposition. The patients were followed for a median time of 3 (1–11) years.Results 1 patient with a pubic tumor developed a local recurrence 1 year after intralesional resection and additional curettage of the margins. The recurrence presented as a small soft tissue mass within the scar tissue of the gluteal muscles and was treated by resection. No secondary sarcoma was detected and none of the patients developed pulmonary metastases or multicentricity. No major complication occurred during surgery.Interpretation We conclude that most GCTs of the pelvis can be treated by intralesional procedures. For tumors of the iliac wing, wide resection can be an alternative. Surgical treatment of tumors affecting the acetabular region often results in functional impairment. Pre-surgical selective arterial embolization appears to be a safe procedure that may reduce the risk of local recurrence.

Intralesional Excision versus Wide Resection for Giant Cell Tumor Involving the Acetabulum: Which is Better?

“…There is no standard treatment procedure for a GCT involving the acetabular bone. The treatment options include radiation therapy [11,12], intralesional curettage with or without adjunctive techniques [5,14,23,25,30,34], and wide resection [5,14,25,30,34]. It is difficult for surgeons to achieve balance between the local control and surgical morbidity in patients with pelvic GCTs.…”

“…Radiation eliminates surgical complications but may cause local injuries such as early and late skin changes, late pathologic fractures, and neuritis [11,12,25,36]. Although curettage preserves the integrity of the pelvis, the local recurrence rate in this region ranges from 6.3% to 43% [5,14,25,30,34], especially in the acetabulum. Wide resection is intended to prevent local recurrence [5,14,25,30,34], but it increases surgical morbidity with complications such as superficial infections (skin sloughs and fistulas), deep infection, hematoma, functional deficits, and problems resulting from reconstruction for iliofemoral stability [16,18,21,28].…”

“…The relatively few articles on GCTs of the pelvis report only five to 19 cases [5,14,23,25,30,34,37]. Owing to their infrequency, the best treatment of pelvic GCTs is controversial.…”

“…Although curettage preserves the integrity of the pelvis, the local recurrence rate in this region ranges from 6.3% to 43% [5,14,25,30,34], especially in the acetabulum. Wide resection is intended to prevent local recurrence [5,14,25,30,34], but it increases surgical morbidity with complications such as superficial infections (skin sloughs and fistulas), deep infection, hematoma, functional deficits, and problems resulting from reconstruction for iliofemoral stability [16,18,21,28]. The scarce literature on this topic provides limited guidance for surgeons to achieve maximum local control and low surgical morbidity in patients with pelvic GCTs.…”

“…Treatment options include radiation therapy [11,12], intralesional curettage with or without adjunctive techniques [5,14,23,25,30,34], and wide resection [5,14,25,30,34]. Radiation eliminates surgical complications but may cause local injuries such as early and late skin changes, late pathologic fractures, and neuritis [11,12,25,36].…”