Long-term follow-up of patients with giant cell tumor of the sacrum treated with selective arterial embolization
Article first published online: 5 SEP 2002
Copyright © 2002 American Cancer Society
Volume 95, Issue 6, pages 1317–1325, 15 September 2002
How to Cite
Lin, P. P., Guzel, V. B., Moura, M. F., Wallace, S., Benjamin, R. S., Weber, K. L., Morello, F. A., Gokaslan, Z. L. and Yasko, A. W. (2002), Long-term follow-up of patients with giant cell tumor of the sacrum treated with selective arterial embolization. Cancer, 95: 1317–1325. doi: 10.1002/cncr.10803
- Issue published online: 5 SEP 2002
- Article first published online: 5 SEP 2002
- Manuscript Accepted: 18 APR 2002
- Manuscript Revised: 20 MAR 2002
- Manuscript Received: 12 DEC 2001
- giant cell tumor of bone;
- therapeutic embolization;
- connective and soft tissue;
- local neoplasm recurrence
Giant cell tumors of the bone can behave as aggressive and sometimes lethal tumors. In the sacrum, the tumor can be extremely difficult to manage. Standard treatments, including surgery and radiation, are associated with significant complications and recurrence rates. The goal of this study is to evaluate the long-term outcome of selective arterial embolization as an alternative treatment modality.
From 1975 to 2001, 18 patients were treated with selective intraarterial embolization. The embolization method was a combination of Gelfoam particles and coils for peripheral and central occlusions, respectively. The number of embolizations was based on clinical symptoms, radiographic response, and the vascularity of the tumor. Nine patients received intraarterial cisplatin as part of their treatment. The median follow-up was 105 months.
Of 18 patients, 14 responded favorably to embolization with improvement in pain and neurologic symptoms. Computed tomographic and magnetic resonance imaging scans showed reossification and stabilization of tumor size. Arteriograms showed diminished vascularity. With long-term follow-up, three patients developed late disease recurrences within the sacrum. Kaplan–Meier analysis showed that the risk of local recurrence is 31% at 10 years and 43% at 15 and 20 years. The long-term outcome was not affected by intraarterial cisplatin. There was one death that occurred 1 day after embolization.
Most patients demonstrate an objective early radiographic response to embolization. Long-term follow-up shows that the response is durable in approximately one half of the patients. Given the potential morbidity of other treatments, embolization should be included in the armamentarium of treatment for this difficult disease. Embolization may be used alone or in conjunction with other therapy. Long-term follow-up is recommended for all patients because late disease recurrence or sarcomatous change can occur. Cancer 2002;95:1317–25. © 2002 American Cancer Society.