Giant cell tumors of the sacrum: is non-operative treatment effective?
- PDF / 1,092,135 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 75 Downloads / 163 Views
ORIGINAL ARTICLE
Giant cell tumors of the sacrum: is non‑operative treatment effective? Ajay Puri1 · Srinath M. Gupta2 · Ashish Gulia2 · Nitin Shetty3 · Siddhartha Laskar4 Received: 26 May 2020 / Accepted: 20 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Giant cell tumors of sacrum in which surgery could endanger important neural components were treated with short term denosumab, angioembolisation and radiotherapy in different combinations to provide a non-operative function preserving treatment option. Methods Between April 2013 and April 2017, 13 sacral GCTs [proximal extent of disease—S1 (10), S2 (2) and S3 (1)] were treated. Age ranged from 20 to 50 years. One patient had loss of bladder control at presentation. Treatment protocol included short term denosumab, angioembolisation and radiotherapy in different combinations. Patients were evaluated every 10–12 weeks. If disease ceased to progress no further treatment was advised. In case of progress, patient was advised additional denosumab and/or angioembolisation and/or radiotherapy till disease stopped progressing. Results 10 patients have non-progressive disease and are asymptomatic, 2 have non-progressive disease with occasional pain, 1 patient died. Follow-up duration (since final non-progression of disease) ranged from 15 to 54 months (mean 31 months). Total number of angio embolisation sessions ranged from 0 to 12 (mean = 4), total number of denosumab doses ranged from 5 to 16 (mean = 9). Five patients did not receive any radiotherapy, 5 received 50.4 Gy and one patient each received 50.4 + 30 + 12 Gy, 50.4 + 30 Gy and 50.4 + 12 Gy. The patient with loss of bladder control at presentation recovered. There were no other long-term complications. Conclusion This study offers a non-surgical management option that provides good mid-term local control while preserving neurological function in these complex lesions. Keywords Function preservation · Denosumab · Angioembolisation · Radiotherapy · Spine tumors
Introduction Giant cell tumors (GCT) are considered as benign aggressive tumors and function preservation is given due consideration when debating treatment options [1, 2]. Sacral giant cell tumors are uncommon, representing about 3–4% of all giant cell tumors [3]. Data derived from the National Cancer Database, a prospectively collected cancer registry (sourced * Ajay Puri [email protected] 1
Orthopaedic Oncology unit of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
2
Orthopaedic Oncology unit of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
3
Interventional Radiology, Tata Memorial Centre, HBNI, Mumbai, India
4
Radiation Oncology, Tata Memorial Centre, HBNI, Mumbai, India
from over 1500 cancer centers) maintained jointly by the American College of Surgeons and the American Cancer Society documented only 51 cases of sacral GCT between the years 2004 and 2016 [4]. In sacral GCTs, while resection improves local control, it may entail loss of bladder and bowel f
Data Loading...
