Intralesional nerve-sparing surgery versus non-surgical treatment for giant cell tumor of the sacrum

BMC Musculoskeletal Disorders

Costantino Errani¹  Davide Maria Donati¹  Nikolin Ali¹  Shinji Tsukamoto²  Yasuhito Tanaka²  Kanya Honoki²  Andreas F. Mavrogenis³  Paolo Spinnato⁴ 

[1] Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy;Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, 634-8521, Nara, Japan;First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Holargos, Athens, Greece;Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy;

关键词: Giant cell tumor of bone;    Sacrum;    Denosumab;    Embolization;    Surgery;    Intralesional nerve sparing surgery;    Curettage;   

DOI  :  10.1186/s12891-021-04907-0

来源: Springer

【 摘 要 】

BackgroundThere is no standard treatment for giant cell tumors of the sacrum. We compared the outcomes and complications in patients with sacral giant cell tumors who underwent intralesional nerve-sparing surgery with or without (neo-) adjuvant therapies versus those who underwent non-surgical treatment (denosumab therapy and/or embolization).MethodsWe retrospectively investigated 15 cases of sacral giant cell tumors treated at two institutions between 2005 and 2020. Nine patients underwent intralesional nerve-sparing surgery with or without (neo-) adjuvant therapies, and six patients received non-surgical treatment. The mean follow-up period was 85 months for the surgical group (range, 25–154 months) and 59 months (range, 17–94 months) for the non-surgical group.ResultsThe local recurrence rate was 44% in the surgical group, and the tumor progression rate was 0% in the non-surgical group. There were two surgery-related complications (infection and bladder laceration) and three denosumab-related complications (apical granuloma of the tooth, stress fracture of the sacroiliac joint, and osteonecrosis of the jaw). In the surgical group, the mean modified Biagini score (bowel, bladder, and motor function) was 0.9; in the non-surgical group, it was 0.5. None of the 11 female patients became pregnant or delivered a baby after developing a sacral giant cell tumor.ConclusionsThe cure rate of intralesional nerve-sparing surgery is over 50%. Non-surgical treatment has a similar risk of complications to intralesional nerve-sparing surgery and has better functional outcomes than intralesional nerve-sparing surgery, but patients must remain on therapy over time. Based on our results, the decision on the choice of treatment for sacral giant cell tumors could be discussed between the surgeon and the patient based on the tumor size and location.

【 授权许可】

CC BY