Dataset Information

Recurrence after and complications associated with adjuvant treatments for sacral giant cell tumor.

ABSTRACT:

Background

The best treatment of giant cell tumor of the sacrum is controversial. It is unclear whether adjuvant treatment with intralesional surgery reduces recurrences or increases morbidity.

Questions/purposes

We therefore asked whether adjuvants altered recurrence rates and complications after intralesional surgery for sacral giant cell tumors.

Methods

We retrospectively studied 31 patients with sacral giant cell tumors treated with intralesional surgery with and without adjuvants. Survival to local recurrence was evaluated using Kaplan-Meier analysis. The differences in survival to local recurrence with and without adjuvants were evaluated using multivariate Cox regression analysis. Complications were recorded from clinical records and images. The minimum followup was 36 months (median, 108 months; range, 36-276 months).

Results

Overall survival to local recurrence was 90% at 60 and 120 months. Survival to local recurrence with and without radiation was 91% and 89%, with and without embolization was 91% and 86%, and with and without local adjuvants was 88% and 92%, respectively. Adjuvants had no influence on local recurrence. Mortality was 6%: one patient died at 14 days postoperatively from a massive pulmonary embolism and another patient had radiation and died of a high-grade sarcoma. Fifteen of the 31 patients (48%) had one or more complications: eight patients (26%) had wound complications and seven patients (23%) had massive bleeding during curettage with hemodynamic instability. L5-S2 neurologic deficits decreased from 23% preoperatively to 13% postoperatively; S3-S4 deficits increased from 16% to 33%.

Conclusions

Adjuvants did not change the likelihood of local recurrence when combined with intralesional surgery but the complication rate was high.

SUBMITTER: Ruggieri P

PROVIDER: S-EPMC2947682 | biostudies-literature | 2010 Nov

REPOSITORIES: biostudies-literature

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Publications

Recurrence after and complications associated with adjuvant treatments for sacral giant cell tumor.

Ruggieri Pietro P Mavrogenis Andreas F AF Ussia Giuseppe G Angelini Andrea A Papagelopoulos Panayiotis J PJ Mercuri Mario M

Clinical orthopaedics and related research 20101101 11

<h4>Background</h4>The best treatment of giant cell tumor of the sacrum is controversial. It is unclear whether adjuvant treatment with intralesional surgery reduces recurrences or increases morbidity.<h4>Questions/purposes</h4>We therefore asked whether adjuvants altered recurrence rates and complications after intralesional surgery for sacral giant cell tumors.<h4>Methods</h4>We retrospectively studied 31 patients with sacral giant cell tumors treated with intralesional surgery with and withou ...[more]

PMID: 20623262

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Project description:ObjectiveTo review the clinical details and further treatments for recurrent spinal giant cell tumors (SGCT), and to analyze the risk factors of recurrence and shed new light on the treatment options and prognosis of recurrent SGCT.MethodsA retrospective analysis of recurrent SGCT between April 2003 and January 2014 was performed. A total of 10 patients comprising 3 men and 7 women with a mean age of 28.9 years (range, 21-40 years) were included in the study. All complete clinical data, radiographs, CT, MRI, scans and pathological data were reviewed. The tumor locations and the regions involved were evaluated by CT and MRI. The blood supply of the tumors was evaluated by enhanced CT and MRI. The mean follow-up was 81.3 months (range, 35.7-172.1 months).ResultsAll patients had Enneking stage 3 tumors; 9 (90%) of them had different extents of spinal canal involvement in the primary time period. All patients underwent intralesional resection during their first surgery. Only 1 patient received local adjuvant treatments; no patient underwent selective arterial embolization or used denosumab at that time. Only 1 patient underwent adjuvant radiotherapy postoperatively, and another patient used bisphosphonates. After recurrence, 1 patient was cured using denosumab, and 2 patients' disease was controlled through use of other medical treatments or adjuvant treatments. There were 3 repeated recurrences and 7 repeated surgical procedures were performed in 5 patients. There were 6 intralesional excisions and 1 decompression surgery. The mean relapse-free time after the first surgery was 32.3 months (range, 10.5-62.6 months). The overall mean relapse-free time was 40.2 months (range, 10.5-157 months). No distant metastasis was found in our series. At the final follow-up, 4 patients were disease free, 3 patients' disease was under control, 2 has progressive disease aggravation, while 1 patient died as a result of progression of disease 133.9 months after first surgery.ConclusionIntralesional excision for recurrent spinal giant cell tumors is an effective option that may have satisfactory prognosis. However, the excision and the inactivation of the lesion should be carried out carefully and thoroughly without missing any corners. Early diagnosis of recurrence may be associated with better prognosis. Adjuvant treatments perioperatively and systemic medical treatments can decrease recurrence rates and can have therapeutic effects in the recurrent SGCT.

Dataset Information

Recurrence after and complications associated with adjuvant treatments for sacral giant cell tumor.

Background

Questions/purposes

Methods

Results

Conclusions

Publications

Recurrence after and complications associated with adjuvant treatments for sacral giant cell tumor.

Similar Datasets

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