Irresectable Aneurysmal Bone Cyst: When Embolization or Radiotherapy Fails to Achieve Local Control
Aneurysmal bone cysts that cannot be surgically removed — or that are situated in locations such as the spine or pelvis where surgery would substantially increase morbidity — present a particular management challenge. When first-line local therapies do not achieve adequate control, a subsequent treatment step is indicated.
Clinical Scenario
This protocol applies when an aneurysmal bone cyst is deemed irresectable, either because of the size of the lesion or because of its anatomic location, where surgery would substantially increase morbidity. In such cases, embolization or radiotherapy are the most often used first-line approaches. Radiotherapy is reserved for irresectable tumors due to the risk of sarcoma induction.
Prior Line — Failure Condition
The preceding treatment line — selective arterial embolization (SAE) or external beam radiotherapy — is directed at achieving local control of the lesion. When that goal is not reached, escalation to this next-line protocol is indicated.
Next-Line Approach
When surgical and local interventions are ineffective or impractical, a systemic medical approach involving a targeted monoclonal antibody class of agent may be considered. Clinical goals include reduction in tumor size on imaging and pain relief. The complete protocol — including full agent selection criteria and management detail — is available via the link below.
References
DOI: 10.7759/cureus.53587
- Radiation therapy is currently reserved for tumors deemed irresectable because of the risk of sarcoma induction.
- In anatomic locations where surgery would substantially increase morbidity, embolization or radiotherapy are the most often used therapies.
- If the size or location (the spine or pelvis) of the lesion makes treatment challenging, this method of treatment is effective.
- Denosumab can be utilized when surgical interventions and/or embolization are ineffective or impractical.
- It has been shown that denosumab can reduce tumor size, which can minimize the potential morbidity of surgical procedures.
- Cornelis et al. observed pain relief with bisphosphonate treatment for benign bone tumors that are symptomatic and inoperable, including ABCs.
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