Treatment of Giant Cell Tumor of Bone of the Pelvis or Sacrum
Giant cell tumor of bone (GCTB) arising in the pelvis or sacrum demands a carefully individualised surgical plan, shaped by where the tumour sits, how far it has extended, and the neural structures at risk in this anatomically complex region.
Clinical scenario: Giant cell tumor of bone localised to the pelvis or sacrum. Both curettage and en bloc resection (EBR) are recognised therapeutic options in this setting.
Approach overview
Surgical strategy — whether nerve-sparing curettage or a more extensive resection with reconstruction — is guided by the anatomical level of the lesion within the sacrum and the degree of cortical destruction and soft-tissue involvement. Preoperative use of a targeted medical agent, over a carefully limited short course, may be considered to optimise surgical conditions; extended preoperative administration is specifically not recommended. The complete decision algorithm, including reconstruction options, is detailed in the full protocol.
References
DOI: 10.3390/curroncol31040157
- Curettage or EBR are therapeutic options in this setting.
- To preserve sacral nerve function (particularly S1, S2, and S3), tumors in the cephalic (above the S3 level) and caudal (below the S3 level) portions are commonly managed with curettage (nerve-sparing surgery) and complete resection, respectively.
- EBR is indicated for lesions with extensive cortical destruction and large soft tissue masses to achieve a safe margin.
- Li et al. evaluated seven patients with pelvic GCTB who underwent EBR and reconstruction with a 3D-printed prosthesis.
- Preoperative treatment with denosumab decreased blood loss during curettage and shortened the operative time.
- It is not recommended to administer denosumab for >3 months prior to surgery for reducing intraoperative blood loss and facilitating surgery.
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