The treatment of sacral giant-cell tumours by serial arterial embolisation

Lackman, Richard D.; Khoury, Laith; Esmail, Ali; Donthineni-Rao, Rakesh

doi:10.1302/0301-620x.84b6.0840873

Cited by 40 publications

(35 citation statements)

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“…54,55 Five-year survival rates as high as 90% have been reported for patients with low-grade tumors, while the corresponding rates for patients with high-grade tumors are 40%-50%. 46,[55][56][57][58][59] We have used image guidance in treating patients with chondrosarcoma to improve our surgical margins while limiting our complications by avoiding excessive bone resection and preserving neurovascular structures. Our intraoperative goal is to obtain at least a 2-cm margin from the tumor seen on intraoperative CT and correlated with MRI.…”

Section: Surgical Pearlsmentioning

confidence: 99%

“…Its ability to halt growth of tumor has been described. [72][73][74] Lackman et al 58 reported on 5 cases of sacral GCT treated solely with recurrent arterial embolization, with 4 demonstrating no growth or recurrence. 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.…”

Section: Surgical Pearlsmentioning

confidence: 99%

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Image-guided resection of aggressive sacral tumors

Drazin¹,

Bhamb

Al-Khouja³

et al. 2017

FOC

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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.

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Section: Surgical Pearlsmentioning

confidence: 99%

Section: Surgical Pearlsmentioning

confidence: 99%

Image-guided resection of aggressive sacral tumors

Drazin¹,

Bhamb

Al-Khouja³

et al. 2017

FOC

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“…Based on the previous inclusion and exclusion criteria, 44 patients from 9 articles were involved in our systematic review; 1 study showing similar data to another was excluded. Among 9 articles, the publication time varied from 1978 to 2013, comprising 34 females and 10 males, with a mean age of 34.4 AE 13.3 years (median, 31.5 years; range, 15-68 years) 20 . …”

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confidence: 99%

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

Sun

et al. 2017

Orthopaedic Surgery

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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...

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“…Partial sacrectomy is used for tumors with substantial involvement of the sacrum below the S2 segment because it can usually be resected with wide margins and allows patients to maintain bowel and bladder control without the need for lumbopelvic reconstruction. If complete resection cannot be easily achieved, preoperative or serial arterial embolization [10,15,17,21,24], intralesional curettage [16,20,27], cryosurgery [20,27], or radiation therapy [16,23] are alternatives. However, the best treatment for giant cell tumor of the sacrum is controversial and the role of adjuvant treatments is unclear [23].…”

Section: Introductionmentioning

confidence: 99%

Recurrence After and Complications Associated With Adjuvant Treatments for Sacral Giant Cell Tumor

Ruggieri

Mavrogenis

Ussia

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The best treatment of giant cell tumor of the sacrum is controversial. It is unclear whether adjuvant treatment with intralesional surgery reduces recurrences or increases morbidity. Questions/purposes We therefore asked whether adjuvants altered recurrence rates and complications after intralesional surgery for sacral giant cell tumors. Methods We retrospectively studied 31 patients with sacral giant cell tumors treated with intralesional surgery with and without adjuvants. Survival to local recurrence was evaluated using Kaplan-Meier analysis. The differences in survival to local recurrence with and without adjuvants were evaluated using multivariate Cox regression analysis. Complications were recorded from clinical records and images. The minimum followup was 36 months (median, 108 months; range, 36-276 months).Results Overall survival to local recurrence was 90% at 60 and 120 months. Survival to local recurrence with and without radiation was 91% and 89%, with and without embolization was 91% and 86%, and with and without local adjuvants was 88% and 92%, respectively. Adjuvants had no influence on local recurrence. Mortality was 6%: one patient died at 14 days postoperatively from a massive pulmonary embolism and another patient had radiation and died of a high-grade sarcoma. Fifteen of the 31 patients (48%) had one or more complications: eight patients (26%) had wound complications and seven patients (23%) had massive bleeding during curettage with hemodynamic instability. L5-S2 neurologic deficits decreased from 23% preoperatively to 13% postoperatively; S3-S4 deficits increased from 16% to 33%. Conclusions Adjuvants did not change the likelihood of local recurrence when combined with intralesional surgery but the complication rate was high.

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The treatment of sacral giant-cell tumours by serial arterial embolisation

Cited by 40 publications

References 0 publications

Image-guided resection of aggressive sacral tumors

Image-guided resection of aggressive sacral tumors

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

Recurrence After and Complications Associated With Adjuvant Treatments for Sacral Giant Cell Tumor

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