Table 5 Overview of studies reporting the result of nerve sparing surgery in sacral giant cell tumor
From: Intralesional nerve-sparing surgery versus non-surgical treatment for giant cell tumor of the sacrum
Nerve sparing surgery without preoperative denosumab treatment | |||||||||
First author, year of publication | Tumor level | Campanacci stage | Local adjuvant therapy | Interval between the first surgery and local recurrence (months) | Number of patients | Local recurrence | Follow-up (months) | Functional outcome | Complications |
Balke, 2012 [20] | NR | NR | Post-op RT: 30% | Mean 12 | 10 | 2 (20%) | Mean 52 | NR | Infection: 10% |
Chen, 2015 [21] | Above S3: 25%; at or below S3: 25%; in both parts: 50% | NR | Zoledronic acid-loaded cement: 100% | NA | 4 | 0 | Mean 28 | Improved: 100% | None |
Chen, 2018 [22] | NR | NR | NR | NR | 10 | 3 (30%) | NR | NR | NR |
Domovitov, 2016 [16] | Above S3: 0%; at or below S3: 8%; in both parts: 92% | Stage 1: 8%; stage 2: 21%; stage 3: 71% | Pre-op RT: 54%; post-op RT: 4%; liquid nitrogen: 79% | NR | 24 | 7 (30%) | Mean 86 | Improved: 79%; stable: 13%; worsen: 8% | Infection: 21%; Skin necrosis: 13%; Rectal fistula: 4%; Avascular necrosis: 8%; Stress fracture due to RT: 8%; Malignant transformation: 4% |
Guo, 2009 [8] | Above S3: 4; at or below S3: 2; in both parts: 18 | Stage 2: 79%; stage 3: 21% | Post-op RT: 8% | Mean 13 | 24 | 7 (29%) | Mean 58 | All the patients were able to walk without an assistive device. Seventeen (70.8%) patients retained normal urinary function and 16 (66.7%) patients preserved normal bowel function. | Infection: 25%; Cerebrospinal fluid leakage: 21%; Deep-vein thrombosis: 4% |
Kollender, 2003 [23] | NR | NR | Cryosurgery: 100% | NA | 3 | 0 | Mean 61 | NR | Infection: 33% |
Li, 2012 [24] | Above S3: 38%; at or below S3: 6%; in both parts: 56% | NR | Post-op RT: 25% | NR | 32 | 12 (38%) | Median 42 | Five patients (15.6%) developed urinary bladder dysfunction and two patients (6.3%) developed bowel dysfunction requiring medication. Four patients with marginal resections had lower limb dysfunction (12.5%). | Malignant transformation: 6%, Infection: 34% |
Lim, 2020 [9] | S1 involvement: 78% | Stage 3: 100% | NR | NR | 36 | 12 (33%) | NR | Mean MUD score increased from 23.9 preoperatively to 25.4 postoperatively. | NR |
Martin, 2010 [25] | Above S3: 50%; at or below S3: 0%; in both parts: 50% | NR | Post-op RT: 50% | Mean 7 | 6 | 2 (33%) | Mean 34 | Normal: 80%, pain and fecal incontinence: 20% | NR |
Ruggieri, 2010 [6] | Above S3: 32%; at or below S3: 6%; in both parts: 61% | Stage 2: 3%, stage 3: 97% | Pre-op RT: 3%; post-op RT: 65%; phenol: 45%; liquid nitrogen: 3% | Within 34 | 31 | 3 (10%) | Median 108 | The incidence of L5-S2 neurologic deficits decreased from 23% preoperatively to 13% postoperatively. The incidence of S3-S4 neurological deficits increased from 16% preoperatively to 33% postoperatively. | Infection: 26%; Massive bleeding: 23% |
Sung, 1982 [31] | S1–3: 100% | NR | NR | 8 | 2 | 1 (50%) | 84 | NR | NR |
Turcotte, 1993 [19] | Above S3: most frequent | NR | RT: 81% | NR | 17 | 17 (100%) | Mean 94 | Improved: 53%; stable: 35%; worsened: 12% | Malignant transformation: 18%; Death due to massive bleeding: 6% |
Thangaraj, 2010 [7] | Above S3: 13%; at or below S3: 13%; in both parts: 75% | NR | NR | Mean 16 | 8 | 3 (38%) | Mean 152 | Improved: 25%, stable: 38%, worsen: 38% | Massive bleeding: 25%; Infection: 13%; RT-induced menopause: 13% |
van der Heijden, 2014 [26] | Above S3: 58%; at or below S3: 4%; in both parts: 38% | NR | RT: 19%; phenol: 15%; liquid nitrogen: 35%; argon beam coagulation: 12% | Median 13 | 26 | 14 (54%) | Median 98 | Median MSTS 24 | Massive bleeding: 15%; Infection: 12%; Drop foot: 12%; Hardware failure: 4%; RT-induced sarcoma: 4%; Fracture due to RT: 4% |
Wang, 2020 [27] | Above S3: 27%; at or below S3: 9%; in both parts: 64% | Stage 2: 18%; stage 3: 82% | NR | NR | 11 | 5 (45%) | Mean 60 | Normal: 64%, urinary and fecal incontinence: 27%, bowel obstruction: 9% | Infection: 36%; Thrombosis due to the aortic balloon occlusion: 9% |
Xu, 2017 [28] | Above S3: 19%; at or below S3: 0%; in both parts: 81% | Stage 2: 13%; stage 3: 88% | RT: 38% | Mean 15 | 16 | 7 (44%) | Mean 92 | Normal: 56% | NR |
Yang, 2018 [29] | Above S3: 100% | Stage 3: 100% | NR | NA | 10 | 0 | Mean 35 | Mean MSTS: 73% | NR |
Zhao, 2020 [10] | Above S3: 24%; at or below S3: 6%; in both parts: 70% | Stage 2: 18%; stage 3: 82% | NR | NR | 89 | 26 (29%) | Median 58 | NR | NR |
Nerve sparing surgery combined with preoperative denosumab | |||||||||
First author, year of publication | Level | Campanacci stage | Number of patients | Local recurrence | Preoperative denosumab | Postoperative denosumab | Follow-up (months) | Functional outcome | Complications |
Chen, 2018 [22] | NR | NR | 10 | 2 (20%) | 1–11 doses | 4–24 doses (9 patients) | NR | NR | Osteonecrosis of the jaw: 0%; Malignant transformation: 10% |
Lim, 2020 [9] | S1 involvement: 94% | Stage 3: 100% | 17 | 3 (18%) | 1–4 doses | Mean 14.8 doses (16 patients) | NR | Mean MUD score increased from 23.9 preoperatively to 25.4 postoperatively. | Malignant transformation: 6% |
Niu, 2019 [32] | NR | Stage 3: 100% | 6 | 3 (50%) | 3–12 months | None | Mean 19 | NR | NR |
Wang, 2020 [27] | Above S3: 25%; at or below S3: 0%; in both parts: 75% | Stage 2: 25%; stage 3: 75% | 4 | 0 | NR | NR | Mean 36 | Normal: 75%; urinary incontinence and bowel obstruction: 25% | Infection: 25% |
Xu, 2017 [28] | Above S3: 21%; at or below S3: 0%; in both parts: 79% | Stage 2: 32%; stage 3: 68% | 19 | 2 (11%) | 1dose bisphosphonate | 2 years bisphosphonate 1 dose at 4-weeks intervals | Mean 47 | Normal: 89% | NR |
Yang, 2018 [29] | Above S3: 100% | Stage 3: 100% | 6 | 4 (67%) | Mean 5.2 months | None | Mean 12 | Mean MSTS 87% | NR |
Zhang, 2019 [30] | S1–3: 67%; S2–4: 33% | Stage 3: 100% | 3 | 2 (67%) | 6 doses | None | Mean 38 | NR | NR |
Zhao, 2020 [10] | Above S3: 24%; at or below S3: 6%; in both parts: 70% | Stage 2: 18%; stage 3: 82% | 19 | 6 (32%) | 1–4 doses | 2–30 doses (18 patients) | Median 58 | NR | NR |