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01.11.2010 | Symposium: Highlights of the ISOLS/MSTS 2009 Meeting | Ausgabe 11/2010

Clinical Orthopaedics and Related Research® 11/2010

Recurrence After and Complications Associated With Adjuvant Treatments for Sacral Giant Cell Tumor

Clinical Orthopaedics and Related Research® > Ausgabe 11/2010
MD, PhD Pietro Ruggieri, MD Andreas F. Mavrogenis, MD Giuseppe Ussia, MD Andrea Angelini, MD, DSc Panayiotis J. Papagelopoulos, MD, PhD Mario Mercuri
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11999-010-1448-8) contains supplementary material, which is available to authorized users.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy, and the ATTIKON University Hospital, Athens University Medical School, Athens, Greece.



The best treatment of giant cell tumor of the sacrum is controversial. It is unclear whether adjuvant treatment with intralesional surgery reduces recurrences or increases morbidity.


We therefore asked whether adjuvants altered recurrence rates and complications after intralesional surgery for sacral giant cell tumors.


We retrospectively studied 31 patients with sacral giant cell tumors treated with intralesional surgery with and without adjuvants. Survival to local recurrence was evaluated using Kaplan-Meier analysis. The differences in survival to local recurrence with and without adjuvants were evaluated using multivariate Cox regression analysis. Complications were recorded from clinical records and images. The minimum followup was 36 months (median, 108 months; range, 36–276 months).


Overall survival to local recurrence was 90% at 60 and 120 months. Survival to local recurrence with and without radiation was 91% and 89%, with and without embolization was 91% and 86%, and with and without local adjuvants was 88% and 92%, respectively. Adjuvants had no influence on local recurrence. Mortality was 6%: one patient died at 14 days postoperatively from a massive pulmonary embolism and another patient had radiation and died of a high-grade sarcoma. Fifteen of the 31 patients (48%) had one or more complications: eight patients (26%) had wound complications and seven patients (23%) had massive bleeding during curettage with hemodynamic instability. L5-S2 neurologic deficits decreased from 23% preoperatively to 13% postoperatively; S3-S4 deficits increased from 16% to 33%.


Adjuvants did not change the likelihood of local recurrence when combined with intralesional surgery but the complication rate was high.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Supplementary material 1 (DOC 105 kb)
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