Posters— Surgical Treatment of Sarcomas

LONG-TERM FOLLOW-UP OF GIANT CELL TUMOR OF THE SACRUM TREATED WITH SELECTIVE ARTERIAL EMBOLIZATION AND OTHER MODALITIES

Lin PP, Guzel VB, Moura MF, Morello FA Jr, Benjamin RS, Gokaslan ZL, Weber KL, and Yasko AW (University of Texas MD Anderson Cancer Center Box 106, Houston TX 77030 USA)

Introduction: Giant cell tumor of the sacrum is difficult to manage. Standard treatment, including surgery and radiation, are associated with significant complications and high relapse rates. The goal of this study is to evaluate the long-term outcome of arterial embolization.

Methods: From 1975 to 2000, 21 patients were treated for giant cell tumor of the sacrum, of which 10 had failed previous treatment. 18 patients underwent selective arterial embolization, of which 8 had bland embolization and 10 had chemoembolization with intra-arterial cis-platin. One patient did not have embolization because of hypovascularity. Two patients underwent total sacrectomy. The mean number of embolizations was 3.8 (range 1 to 7). The median follow-up time was 105 months (range 6 to 205 months). Results: Of the patients who underwent embolization, four failed to show a positive radiographic response (decrease in vascularity and increase in peripheral bone formation). Three additional patients had late failure of treatment. In the most favorable model, the rate of local control with embolization was 64% at 5 years and 51% at ten years by Kaplan-Meier analysis. Patients undergoing chemoembolization with intra-arterial cis-platin did not have significantly better local control than bland embolization without chemotherapy, but this was not randomized, and in certain cases a positive effect was noted with cis-platin. Radiation provided long-term control in 2 patients after failure of other treatments. Three patients developed radiation sarcomas. Aggressive surgical excision was effective in obtaining local control, but functional results varied widely.

Discussion and Conclusion: The treatment of sacral giant cell tumor continues to be problematic. Both surgery and radiation can result in significant morbidity. Arterial embolization has some efficacy, but half of the patients will ultimately fail treatment. Nevertheless, it is a potentially useful modality. A minority of patients can have their disease controlled by embolization alone. Many patients show a partial response and, this may make surgical excision safer and less morbid. A multimodality approach may provide optimal results.