Current Treatment of Sacral Giant Cell Tumour of Bone: A Review

Abstract

Sacral giant cell tumour of bone has an insidious onset and slow growth rate, making early diagnosis difficult. The tumour has a high recurrence rate and is often fatal. Magnetic resonance imaging and computed tomography (CT), including CT-guided fine-needle biopsy, are useful for early diagnosis. Although therapy for sacral giant cell tumour often involves surgical resection and reconstruction challenges, improvements in various treatment modalities, including arterial embolization and radiotherapy, have widened the effective treatment options. The current surgical and adjuvant treatment modalities available for the management of sacral giant cell tumour are systematically reviewed and a suggested treatment algorithm is provided. En bloc excision remains the surgical procedure of choice, with functional reconstruction important in cases where the lesion is high in the sacrum. The use of adjuvant radiotherapy and chemotherapy remains controversial and should be studied further. Determination of the optimum treatment for sacral giant cell tumour will require randomized controlled trials. Early diagnosis, complete surgical resection with tumour-free margins and comprehensive treatment are important for local tumour control and improved outcome.

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

“…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 psychological issues after surgery 13 .…”

“…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 psychological issues after surgery 13 .…”

Modified Kraske Procedure with Mid-Sacrectomy and Coccygectomy forEn BlocExcision of Sacral Giant Cell Tumors

“…They are locally highly aggressive and present a high recurrence rate and the power to metastasize, being associated with high morbidity [2, 9–13]. Although considered benign, they are usually lethal, making them a complex medical disease [14–16]. Distant metastization is unusual.…”

Management and retrospective analysis of primary and metastatic sacral tumors and infections: evaluation with 73 cases

“…While en bloc resection is the gold standard treatment choice in sacral GCT, adjuvant treatments like intracavitary cryotherapy or thermo cauterization followed by intralesional excision is an alternative treatment modality although it is associated with a high recurrence rate. [3] The accepted treatment for sacral aneurysmal bone cysts and osteoblastoma is aggressive curettage followed by local adjuvant treatments and bone grafting. [4] Most common primer malignant tumors located in sacrum are low-grade malignancies like chordoma or chondrosarcoma.…”

“…[1,2] En bloc resection with functional reconstruction in cases where the lesion is high in the sacrum has been demonstrated to increase the disease-free survival period unresponsive to chemotherapy and radiotherapy. [3] Primary high-grade malignant tumors, including osteosarcoma, chondrosarcoma, and Ewing sarcoma (ES) are extremely rare in the sacrum, and intralesional resection without adequate margins may lead to high local recurrence rates. [5] Metastases are in fact the most common malignant tumors of the sacrum with poor survival rates.…”