The analysis of the treatment of giant cell tumor of the pelvis and sacrum

Abstract

To discuss the surgical management, local recurrence rate and complications of giant cell tumor (GCTs) of the pelvic and sacrum. From December 1997 to December 2005 the data of 46 patients of GCTs of pelvic and sacrum treated were reviewed. There were 25 men and 21 women with the average age of 32 years old ranging from 17 to 64. Out of 46 patients,there were 24 tumors involved the sacrum and the others at the pelvis. According to the site of the tumors on the bone, they was classified into three regions: 8 patients involved region I (ilium), 10 region II (acetabulum) and 4 region III (ischiopubic). Two patients had lesions located at S(1-5), 4 at S(1-4), 12 at S(1-3), 5 at S(1-2) and 1 at S(3-5). Surgical management: 2 patients received 3 times of operations and 7 underwent 2 operations. There were 19 patients managed with intralesional marginal excision and 2 patients with intralesional marginal excision and adjuvant radiotherapy, another 3 patients with widely marginal excision as the treatment of sacral lesions. Nineteen patients underwent the enbloc excision except 2 involved ischium and 1 involved ilium for the managements of pelvic lesions. One recurrent patient with the large, ragged tumor died of serious infection in 2 weeks after the second surgery. The remain 45 patients had followed-up durations ranging from 12 months to 8 years. One patient of malignant giant cell tumor of sacrum died at 15 months after surgery. One patient with postoperation sarcoma underwent reoperation and radiotherapy but died at the 13th month. One patient with sacral lesion occurred pulmonary metastases in two years after surgery, and received chemotherapy with ADM, DDP and IFO. One year later there was no much change in metastatic tumor. One patient with acetabular lesion underwent curettage before local recurrence and pulmonary metastases were found in 2 years. The patient was treated with pulmonary radiation, widely marginal excision and hemi-pelvic prostheses reconstruction. There was no progression in metastatic lesion during the following up. The local recurrence rate of GCT at sacrum was 9/24 (37.5%), and at pelvis was 2/22 (9.1%). However, 2 patients with ischium lesions both recurred after curettage. Nineteen lesions with enbloc excision showed no recurrence at all. The treatment for GCT of the pelvic and sacrum should be more aggressive because of high incidence of local recurrence after intralesional excision. Although it might induce sacral nerve deficit, widely marginal excision is the best surgical procedure because of its low recurrence rate.