Giant cell tumors of the sacrum--a nationwide study on midterm results in 26 patients after intralesional excision

L van der Heijden; M A J van de Sande; I C M van der Geest; H W B Schreuder; B J van Royen; P C Jutte; J A M Bramer; F C Öner; A P van Noort-Suijdendorp; H M Kroon; P D S Dijkstra

doi:10.1007/s00586-014-3263-5

Giant cell tumors of the sacrum--a nationwide study on midterm results in 26 patients after intralesional excision

Eur Spine J. 2014 Sep;23(9):1949-62. doi: 10.1007/s00586-014-3263-5. Epub 2014 Mar 11.

Authors

L van der Heijden¹, M A J van de Sande, I C M van der Geest, H W B Schreuder, B J van Royen, P C Jutte, J A M Bramer, F C Öner, A P van Noort-Suijdendorp, H M Kroon, P D S Dijkstra

Affiliation

¹ Department of Orthopedic Surgery, Leiden University Medical Center (LUMC), Postzone J11-70, PO Box 9600, 2300 RC, Leiden, The Netherlands, lvanderheijden@lumc.nl.

PMID: 24614982
DOI: 10.1007/s00586-014-3263-5

Abstract

Purpose: Evaluation of recurrences, complications and function at mid-term follow-up after curettage for sacral giant cell tumor (GCT).

Methods: We retrospectively studied all 26 patients treated for sacral GCT in the Netherlands (from 1990 to 2010). Median follow-up was 98 (6-229) months. All patients underwent intralesional excision, 21 with local adjuvants, 5 radiotherapy, 3 IFN-α, 1 bisphosphonates. Functional outcome was assessed using Musculoskeletal Tumor Society (MSTS) score. Statistics were performed with Kaplan-Meier, Cox regression, log rank and Mann-Whitney U.

Results: Recurrence rate was 14/26 after median 13 (3-139) months and was highest after isolated curettage (4/5). Soft tissue masses >10 cm increased recurrence risk (HR = 3.3, 95 % CI = 0.81-13, p = 0.09). Complications were reported in 12/26 patients. MSTS was superior in patients without complications (27 vs. 21; p = 0.024).

Conclusion: Recurrence rate for sacral GCT was highest after isolated curettage, indicating that (local) adjuvant treatment is desired to obtain immediate local control. Complications were common and impaired function.

MeSH terms

Adolescent
Adult
Aged
Bone Density Conservation Agents / therapeutic use
Bone Neoplasms / mortality
Bone Neoplasms / surgery*
Bone Neoplasms / therapy*
Chemoradiotherapy, Adjuvant / methods
Curettage
Diphosphonates / therapeutic use
Female
Follow-Up Studies
Giant Cell Tumor of Bone / mortality
Giant Cell Tumor of Bone / surgery*
Giant Cell Tumor of Bone / therapy*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Recurrence, Local
Netherlands
Postoperative Complications / mortality
Retrospective Studies
Risk Factors
Sacrum / surgery*
Treatment Outcome
Young Adult

Substances

Bone Density Conservation Agents
Diphosphonates