Document Type: SHORT COMMUNICATION

Authors

Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

There are still some debates regarding the best treatment of Giant Cell Tumor (GCT) of the sacrum. Since GCT of this location is rare, therapeutic strategies are mainly based on the treatment of GCT in other anatomic locations. The objective of this study was to evaluate the oncologic and clinical results of surgical management of sacral GCT with and without local adjuvant therapy. Medical records of 19 patients diagnosed with GCT of the sacrum, were retrospectively reviewed. Sixteen patients were treated by intralesional curettage and three patients with marginal resection. Musculoskeletal tumor society (MSTS) score was used for the evaluation of functional outcome. Prolonged pain was the most common complication after treatment. Mean Pre and post-operative pain based on visual analogue scale (VAS) was 6.1 ± 1.99 and 3.05 ± 1.64, respectively. Postoperative neurologic deficit appeared in six patients. In addition, infection occurred in five patients. One case of spinopelvic instability was also observed after surgery. At average follow up of 158.5 ± 95.9 months (25 to 316 months), recurrence was seen in eight (42.7%) out of seventeen patients treated by intralesional curettage. The size of the tumor significantly correlated with the tumor recurrence (r=0.654, P=0.001). Mean MSTS score was 74.7 ± 16.78. Those patients, in whom sacral nerve roots remained intact before and after surgery, had better functional outcome. Preservation of sacral nerve roots is associated with better functional outcome and less pain. Although an acceptable surgical outcome was observed in our cohort, the problem of local recurrence still warrants further investigations for better local control of the tumor.

Keywords

Main Subjects

1. Balke M, Henrichs MP, Gosheger G, Ahrens H,
Streitbuerger A, Koehler M, et al. Giant cell tumors of
the axial skeleton. Sarcoma. 2012;1-10:)410973(2012 .
2. Domovitov SV, Chandhanayingyong C, Boland PJ,
McKeown DG, Healey JH. Conservative surgery in the
treatment of giant cell tumor of the sacrum: 35 years’
experience. J Neurosurg Spine. 2015; 30(2):1-13.
3. Leggon RE, Zlotecki R, Reith J, Scarborough MT. Giant
cell tumor of the pelvis and sacrum: 17 cases and
analysis of the literature. Clin Orthop Relat Res. 2004;
423(1):196-207.
4. Balke M, Streitbuerger A, Budny T, Henrichs M,
Gosheger G, Hardes J. Treatment and outcome of
giant cell tumors of the pelvis. Acta Orthop. 2009;
80(5):590-6.
5. Thangaraj R, Grimer R, Carter SR, Stirling AJ, Spilsbury
J, Spooner D. Giant cell tumour of the sacrum: a
suggested algorithm for treatment. Eur Spine J. 2010;
19(7):1189-94.
6. Gunterberg B, Romanus B, Stener B. Pelvic strength
after major amputation of the sacrum: an experimental
study. Acta Orthop Scand. 1976; 47(6):635-42.
7. Jimenez M. Pelvis, acetabulum, and hip trauma.
In: Baratz M, Watson AD, Imbriglia JE, editors.
Orthopaedic surgery: the essentials. New York:
Thieme; 1999. P. 467–94.
8. Enneking WF, Dunham W, Gebhardt MC, Malawar M,
Pritchard DJ. A system for the functional evaluation
of reconstructive procedures after surgical treatment
of tumors of the musculoskeletal system. Clin Orthop
Relat Res. 1993; 286(1):241-6.
9. Carlsson AM. Assessment of chronic pain. I. Aspects of
the reliability and validity of the visual analogue scale.
Pain. 1983; 16(1):87-101.
10. Gibbons KJ, Soloniuk DS, Razack N. Neurological
injury and patterns of sacral fractures. J Neurosurg.
1990; 72(6):889-93.
11. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar
N, Masri BA, et al. Giant cell tumor of long bone: a
Canadian Sarcoma Group study. Clin Orthop Relat Res.
2002; 397(1):248-58.
12. Balke M, Schremper L, Gebert C, Ahrens H,
Streitbuerger A, Koehler G, et al. Giant cell tumor of
bone: treatment and outcome of 214 cases. J Cancer
Res Clin Oncol. 2008; 134(9):969-78.
13. Blackley HR, Wunder JS, Davis AM, White LM, Kandel
R, Bell RS. Treatment of giant-cell tumors of long
bones with curettage and bone-grafting. J Bone Joint
Surg Am. 1999; 81(6):811-20.
14. Martin C, McCarthy EF. Giant cell tumor of the sacrum
and spine: series of 23 cases and a review of the
literature. Iowa Orthop J. 2010; 30(1):69.
15. Guo W, Ji T, Tang X, Yang Y. Outcome of conservative
surgery for giant cell tumor of the sacrum. Spine.
2009; 34(10):1025-31.
16. Marcove RC, Sheth DS, Brien EW, Huvos AG, Healey
JH. Conservative surgery for giant cell tumors of the
sacrum. The role of cryosurgery as a supplement
to curettage and partial excision. Cancer. 1994;
74(4):1253-60.
17. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs
CP, Mendenhall NP. Giant cell tumor of bone. Am J Clin
Oncol. 2006; 29(1):96-9.
18. Balke M, Ahrens H, Streitbuerger A, Koehler G,
Winkelmann W, Gosheger G, et al. Treatment options
for recurrent giant cell tumors of bone. J Cancer Res
Clin Oncol. 2009; 135(1):149-58.
19. Hosalkar HS, Jones KJ, King JJ, Lackman RD. Serial
arterial embolization for large sacral giant-cell
tumors: mid-to long-term results. Spine. 2007;
32(10):1107-15.
20. Lin PP, Guzel VB, Moura MF, Wallace S, Benjamin RS,
Weber KL, et al. Long-term follow-up of patients with
giant cell tumor of the sacrum treated with selective

arterial embolization. Cancer. 2002; 95(6):1317-25.
21. Lackman RD, Khoury LD, Esmail A, Donthineni-Rao R.
The treatment of sacral giant-cell tumours by serial
arterial embolisation. J Bone Joint Surg Br. 2002;
84(6):873-7.
22. Chakravarti A, Spiro IJ, Hug EB, Mankin HJ, Efird JT,
Suit HD. Megavoltage radiation therapy for axial and
inoperable giant-cell tumor of bone. J Bone Joint Surg
Am. 1999; 81(11):1566-73.
23. Thomas D, Chawla SP, Skubitz K, Staddon AP, Henshaw
R, Blay J, et al. Denosumab treatment of giant cell
tumor of bone: Interim analysis of an open-label
phase II study. J Clin Oncol. 2008; 26(15):10500.
24. Chan CM, Adler Z, Reith JD, Gibbs CP. Risk factors for
pulmonary metastases from giant cell tumor of bone.
J Bone Joint Surg Am. 2015; 97(5):420-8.
25. Roux S, Mariette X. RANK and RANKL expression
in giant-cell tumour of bone. Lancet Oncol. 2010;
11(6):514.
26. Branstetter DG, Nelson SD, Manivel JC, Blay JY,
Chawla S, Thomas DM, et al. Denosumab induces
tumor reduction and bone formation in patients
with giant-cell tumor of bone. Clin Cancer Res. 2012;
18(16):4415-24.
27. Thomas D, Henshaw R, Skubitz K, Chawla S, Staddon
A, Blay JY, et al. Denosumab in patients with giant-cell
tumour of bone: an open-label, phase 2 study. Lancet
Oncol. 2010; 11(3):275-80.
28. Chawla S, Henshaw R, Seeger L, Choy E, Blay JY,
Ferrari S, et al. Safety and efficacy of denosumab for
adults and skeletally mature adolescents with giant
cell tumour of bone: interim analysis of an open-label,
parallel-group, phase 2 study. Lancet Oncol. 2013;
14(9):901-8.
29. Watanabe Y, Kaya M, Sasaki M, Emori M, Murahashi
Y, Mizushima E, et al. Experience using denosumab
for lung metastases of giant cell tumor of bone. Eur
Orthop Traumatol. 2015; 6(3):239-41.
30. Yamagishi T, Kawashima H, Ogose A, Sasaki T, Hotta
T, Inagawa S, et al. Disappearance of giant cells and
presence of newly formed bone in the pulmonary
metastasis of a sacral giant-cell tumor following
denosumab treatment: a case report. Oncol Lett.
2016; 11(1):243-6.