title: Serial arterial embolization for large sacral giant-cell tumors: mid- to long-term results.
abstract: METHODS
  Level III retrospective case series with historical controls.
  
  
  OBJECTIVE
  To evaluate the mid- to long-term outcomes of serial arterial embolization as a primary treatment modality for large sacral giant-cell tumors (SGCT).
  
  
  BACKGROUND
  Giant-cell tumors are potentially aggressive benign tumors that can cause significant morbidity and may occasionally prove lethal. Large GCTs in the sacrum present a significant challenge, and treatment methods, including surgical resection and radiation, are associated with morbid complications and high recurrence rates. This report presents the mid- to long-term follow-up results of our cases of SGCT treated with serial arterial embolization.
  
  
  METHODS
  Nine consecutive patients with biopsy-proven SGCTs received initial primary treatment with serial arterial embolization between 1984 and 2006. All patients underwent angiography and selective arterial embolization at the time of diagnosis, followed by repeat embolization every 6 weeks until no new vessels were noted, and then at 6 and 18 months following stabilization of the lesion. Patients were closely monitored with MRI and/or CT every 6 months for 5 years and annually thereafter. Functional outcomes were measured using the 1993 Musculoskeletal Tumor Society Rating Scale (MSTS93).
  
  
  RESULTS
  The mean duration of follow-up in this series was 8.96 years (median, 7.8 years; range, 3.8-21.2 years). No progression was noted in 7 of the 9 cases. Two cases experienced tumor progression of less than 1 cm early in the treatment course and continued to remain asymptomatic. Adjuvant radiation therapy provided local control in 1 of these cases, while radiation and chemotherapy failed in the other case with ultimate mortality. All patients demonstrated substantial pain relief. Cross-sectional MSTS93 scores were obtained in the 8 surviving patients at their most recent follow-up visit with a mean score of 29/30.
  
  
  CONCLUSIONS
  Serial arterial embolization is a useful primary treatment modality for large SGCTs given the favorable long-term results and potential morbidity of alternative treatments.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19106, USA.
authors.forename: Harish S
authors.initials: HS
authors.lastname: Hosalkar
authors.forename: Kristofer J
authors.initials: KJ
authors.lastname: Jones
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: King
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lackman
mesh_terms: D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005263:Femoral Artery; D005870:Giant Cell Tumors / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging; D013125:Spinal Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome