Orthopaedic Oncology unit of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.
Interventional Radiology, Tata Memorial Centre, HBNI, Mumbai, India.
Eur Spine J. 2021 Oct;30(10):2881-2886. doi: 10.1007/s00586-020-06650-x. Epub 2020 Oct 26.
Giant cell tumors of sacrum in which surgery could endanger important neural components were treated with short term denosumab, angioembolisation and radiotherapy in different combinations to provide a non-operative function preserving treatment option.
Between April 2013 and April 2017, 13 sacral GCTs [proximal extent of disease-S1 (10), S2 (2) and S3 (1)] were treated. Age ranged from 20 to 50 years. One patient had loss of bladder control at presentation. Treatment protocol included short term denosumab, angioembolisation and radiotherapy in different combinations. Patients were evaluated every 10-12 weeks. If disease ceased to progress no further treatment was advised. In case of progress, patient was advised additional denosumab and/or angioembolisation and/or radiotherapy till disease stopped progressing.
10 patients have non-progressive disease and are asymptomatic, 2 have non-progressive disease with occasional pain, 1 patient died. Follow-up duration (since final non-progression of disease) ranged from 15 to 54 months (mean 31 months). Total number of angio embolisation sessions ranged from 0 to 12 (mean = 4), total number of denosumab doses ranged from 5 to 16 (mean = 9). Five patients did not receive any radiotherapy, 5 received 50.4 Gy and one patient each received 50.4 + 30 + 12 Gy, 50.4 + 30 Gy and 50.4 + 12 Gy. The patient with loss of bladder control at presentation recovered. There were no other long-term complications.
This study offers a non-surgical management option that provides good mid-term local control while preserving neurological function in these complex lesions.
对于手术可能危及重要神经结构的骶骨巨细胞瘤，采用短期地舒单抗、血管栓塞和放疗的不同组合进行治疗，以提供一种非手术保留功能的治疗选择。
2013 年 4 月至 2017 年 4 月，共治疗了 13 例骶骨 GCT[疾病的近端范围-S1（10）、S2（2）和 S3（1）]。年龄在 20 至 50 岁之间。1 例患者在就诊时出现膀胱控制丧失。治疗方案包括短期地舒单抗、血管栓塞和放疗的不同组合。患者每 10-12 周进行一次评估。如果疾病停止进展，不建议进一步治疗。如果病情进展，建议患者接受额外的地舒单抗和/或血管栓塞和/或放疗，直至疾病停止进展。
10 例患者疾病无进展，且无症状，2 例患者疾病无进展，但偶有疼痛，1 例患者死亡。随访时间（自疾病最后一次非进展起）为 15 至 54 个月（平均 31 个月）。血管栓塞治疗的总次数为 0 至 12 次（平均 4 次），地舒单抗的总剂量为 5 至 16 次（平均 9 次）。5 例患者未接受任何放疗，5 例患者接受 50.4Gy，1 例患者分别接受 50.4Gy+30Gy+12Gy、50.4Gy+30Gy 和 50.4Gy+12Gy。在就诊时出现膀胱控制丧失的患者已恢复。无其他长期并发症。
本研究提供了一种非手术治疗选择，在保留这些复杂病变的神经功能的同时，可获得良好的中期局部控制。
