Long-term follow-up of patients with giant cell tumor of the sacrum treated with selective arterial embolization.
BACKGROUND
Giant cell tumors of the bone can behave as aggressive and sometimes lethal tumors. In the sacrum, the tumor can be extremely difficult to manage. Standard treatments, including surgery and radiation, are associated with significant complications and recurrence rates. The goal of this study is to evaluate the long-term outcome of selective arterial embolization as an alternative treatment modality.


METHODS
From 1975 to 2001, 18 patients were treated with selective intraarterial embolization. The embolization method was a combination of Gelfoam particles and coils for peripheral and central occlusions, respectively. The number of embolizations was based on clinical symptoms, radiographic response, and the vascularity of the tumor. Nine patients received intraarterial cisplatin as part of their treatment. The median follow-up was 105 months.


RESULTS
Of 18 patients, 14 responded favorably to embolization with improvement in pain and neurologic symptoms. Computed tomographic and magnetic resonance imaging scans showed reossification and stabilization of tumor size. Arteriograms showed diminished vascularity. With long-term follow-up, three patients developed late disease recurrences within the sacrum. Kaplan-Meier analysis showed that the risk of local recurrence is 31% at 10 years and 43% at 15 and 20 years. The long-term outcome was not affected by intraarterial cisplatin. There was one death that occurred 1 day after embolization.


CONCLUSIONS
Most patients demonstrate an objective early radiographic response to embolization. Long-term follow-up shows that the response is durable in approximately one half of the patients. Given the potential morbidity of other treatments, embolization should be included in the armamentarium of treatment for this difficult disease. Embolization may be used alone or in conjunction with other therapy. Long-term follow-up is recommended for all patients because late disease recurrence or sarcomatous change can occur.
Lin
Patrick P
PP
Section of Orthopaedic Oncology, M. D. Anderson Cancer Center, Houston, Texas 77030, USA. plin@mdanderson.org
Guzel
Volkan B
VB
Moura
Marcio F
MF
Wallace
Sidney
S
Benjamin
Robert S
RS
Weber
Kristin L
KL
Morello
Frank A
FA
Gokaslan
Ziya L
ZL
Yasko
Alan W
AW
D000293:Adolescent; D000328:Adult; D000792:Angiography; D001158:Arteries; D001859:Bone Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable; D018212:Giant Cell Tumor of Bone / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol; D012447:Sacrum; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011142:Polyvinyl Alcohol; D002945:Cisplatin