Treatment and outcome of giant cell tumors of the pelvis

Figures & data

Data on 20 patients with giant cell tumor of bone

A	B	C	D	E	F	G	H	I	J	K	L	M	N
1	M	38	I	Ilium with sacral extension	L	3	+	A	SAE, curettage, burring + PMMA 03/99	–	19	NED
2	M	33	I	Ilium with sacral extension	L	3	+	A	SAE, curettage, H2O2, cryotherapy + PMMA 06/95	–	38	NED	+
3	F	44	I	Ilium	L	3	+	A	Curettage + PMMA 12/89	–	30	NED	+
4	F	17	I	Ilium	L	n.d.		A	Curettage + bone graft 01/90	–	34	NED	+
5	F	35	I	Ilium with sacral extension	L	3	+	B	SAE, curettage + PMMA, partial sacral resection 09/89	–	128	NED
6	F	35	I	Ilium	R	3	+	C	SAE, wide resection of ilium 11/04	–	33	NED
7	M	65	I	Ilium	L	2	+	C	Wide resection of ilium 06/05	–	46	NED	+
8	M	27	I	Ilium	R	3	+	C	Wide resection of ilium 10/04	–	55	NED	+
9	F	35	I	Ilium with sacral extension and extension to lumbar spine (L5)	R	3	nd	D	EBI with 50 Gy 05/97–07/97, SAE, ILR + curettage of margins, H2O2 + PMMA 09/97	–	123	NED	+
10	F	57	III–II	Ischiopubis with acetabular extension and path. fracture	R	3	–	A	SAE, curettage, burring + PMMA 10/00	–	87	NED	+
11	F	43	III–II	Ischium with acetabular extension	R	3	+	B	SAE, ILR + curettage of margins + PMMA 09/05	–	45	NED	+
12	F	29	III–II	Pubis with acetabular extension	R	3	+	B	SAE, ILR + curettage of margins + hip transposition 02/00	–	112	NED	+
13	M	31	III–II	Ischium with acetabular extension	L	3	+	B	SAE, ILR + curettage and burring of margins, PMMA 05/05	–	22	NED	+
14	F	60	III–II	Pubis with acetabular extension	L	3	+	D	Curettage + cryotherapy + bone graft 10/95, adjuvant EBI with 50 Gy 01/96–03/96	–	20	NED
15	M	47	III–II	Ischiopubis with acetabular extension and soft tissue infiltration of adductor muscles	L	3	+	E	Sole treatment with EBI using proton beam radiation 10/04–12/04	–	30	SD	+
16	F	38	III	Ischium	L	3	+	A	Curettage, burring and H2O2 + bone graft + PMMA 07/00	–	14	NED
17	F	48	III	Pubis	L	n.d.		A	Curettage, phenol + bone graft 01/99	–	13	NED	+
18	M	52	III	Pubis	L	2	+	A	Curettage, burring + PMMA 08/01	–	72	NED
19	F	54	III	Pubis	L	2	–	B	ILR + curettage and burring of margins 04/07	+	25	NED	+
20	M	59	III	Pubis	R	3	–	B	ILR + curettage and burring of margins + PMMA 02/08	–	12	NED

A Case

B Sex

C Age

D Region / site of lesion: Grouping of anatomical site (Enneking and Dunham 1978, Sanjay et al. 1993): I, iliosacral; II, ischiopubic with acetabular extension; III, ischiopubic.

E Region / site of lesion

F Side: L, left; R, right.

G Stage

H Soft tissue extension: –, no; +, yes; n.d., not documented.

I Grouping of treatment regimen: A, intralesional curettage; B, intralesional resection of mainly affected bone and extension of margins by curettage; C, wide resection; D, external beam irradiation (EBI) combined with surgery; E, EBI with proton beam radiation.

J Treatment: PMMA, polymethyl methacrylate (bone cement); ILR, intralesional resection; SAE, selective arterial embolization; EBI, external beam irradiation.

K Local recurrence: –, no; +, yes.

L Follow-up (months).

M Status: NED, no evidence of disease; SD, stable disease; ABC: aneurysmal bone cyst.

N Comments: +, yes. See below. Case:

2. Secondary aneurysmal bone cyst.

3. Referred to us due to local infection after biopsy in another hospital; 3 revisions in 01/99.

4. Treatment in other hospital, referred to us to exclude recurrence in 10/92.

7. Limping using a cane.

8. Secondary aneurysmal bone cyst.

9. Referred to us 4 months after biopsy and progressive disease. Postoperative impaired wound healing and local infection, resection, and hip transposition 10/97, removal of PMMA + debridement 11/97.

10. Endoprosthesis with acetabular reconstruction in 06/01 due to femoral head necrosis; limping, using 1 cane for longer walks.

11. Dislocation of screw for PMMA fixation, local pain, removal of screw in 01/09.

12. Secondary ABC, resection of scar tissue in 04/01, subluxation of femoral head; limping but free from pain; use of cane for longer walks.

13. Dislocation of screw for PMMA fixation in 08/05, removal of screw; occasionally minimal pain.

15. Stable disease, additional treatment with oral bisphosphonates, acetabular protrusion.

17. Treatment in other hospital, referred to us to exclude recurrence in 09/99.

19. Secondary ABC, soft tissue recurrence treated by wide resection in 04/08; occasionally moderate pain in pubic and gluteal area while sitting.

20. Surgical excision of sigmoidal gastrointestinal stroma tumor in 01/08; occasionally minimal local pain.

Figure 1. Localization of main tumor components. 3 groups according to Enneking and Dunham (1978). Region I: iliosacral area; region II: acetabular area; region III: ischiopubic area. 9 tumors affected region I, 6 affected region II, and 5 affected region III.

Figure 2. Case 2. a. GCT of the left ilium with sacral extension and proximal cortical breakthrough. b. After intralesional curettage and bone cement packing of the defect.

Figure 3. Case 20. a. GCT of the right pubic bone with bony destruction. b. After intralesional resection of pubic bone, including the symphysis. Proximal margins were additionally curetted and cemented. Note the multiple hemostatic clips.

Figure 4. Case 7. a. Giant cell tumor of the left iliac wing. b. After wide resection of the left iliac wing without reconstruction.

Figure 5. Case 11. a. After intralesional resection of a GCT of the ischium. Additional curettage and bone cement packing of the acetabular extension was performed. The cement was fixed with 2 screws to prevent dislocation. b. CT showing dislocation of the dorsal screw, necessitating surgical removal.

Enneking WF, Dunham WK.. Resection and reconstruction for primary neoplasms involving the innominate bone.. J Bone Joint Surg (Am) 1978; 60 (6): 731–46.

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Sanjay BK, Frassica FJ, Frassica DA, Unni KK, McLeod RA, Sim FH.. Treatment of giant-cell tumor of the pelvis.. J Bone Joint Surg (Am) 1993; 75 (10): 1466–75.

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