Zoledronic acid-loaded bone cement as a local adjuvant therapy for giant cell tumor of the sacrum after intralesional curettage.

Abstract

Giant cell tumor of the sacrum is usually silent in initial stages and not diagnosed until achieving a large size. Intralesional curettage of the tumor has lower risk of neurological damage but is with high recurrence rate. Zoledronic acid-loaded cement was demonstrated to have cytotoxic effect on the cell line of giant cell tumor. This study evaluate if zoledronic acid-loaded bone cement would reduce the recurrence rate of sacral giant cell tumor after intralesional curettage. Four patients were diagnosed as sacral giant cell tumor and received intralesional curettage with placement of zoledronic acid-loaded bone cement for adjuvant local control. The clinical records including tumor location, tumor size, complication, follow-up status, and functional outcome were analyzed retrospectively. All four patients presented with cauda equina syndrome before surgery with mean tumor volume of 472.8 cm(3). With placement of zoledronic acid-loaded cement, no local recurrence was observed during the mean follow-up period of 28months. All patients were found to have new bone regeneration on radiograph. All patients suffering from cauda equina syndrome were recovered. We suggested that placement of zoledronic acid-loaded bone cement was an effective adjuvant therapy for sacral giant cell tumor following intralesional curettage.