Zoledronic acid-loaded bone cement as a local adjuvant therapy for giant cell tumor of the sacrum after intralesional curettage

Abstract

Purpose: Giant cell tumor of the sacrum is usually silent in initial stages and not diagnosed until achieving a large size. Intralesional curettage of the tumor has lower risk of neurological damage but is with high recurrence rate. Zoledronic acid-loaded cement was demonstrated to have cytotoxic effect on the cell line of giant cell tumor. This study evaluate if zoledronic acid-loaded bone cement would reduce the recurrence rate of sacral giant cell tumor after intralesional curettage.

Methods: Four patients were diagnosed as sacral giant cell tumor and received intralesional curettage with placement of zoledronic acid-loaded bone cement for adjuvant local control. The clinical records including tumor location, tumor size, complication, follow-up status, and functional outcome were analyzed retrospectively.

Results: All four patients presented with cauda equina syndrome before surgery with mean tumor volume of 472.8 cm(3). With placement of zoledronic acid-loaded cement, no local recurrence was observed during the mean follow-up period of 28 months. All patients were found to have new bone regeneration on radiograph. All patients suffering from cauda equina syndrome were recovered.

Conclusions: We suggested that placement of zoledronic acid-loaded bone cement was an effective adjuvant therapy for sacral giant cell tumor following intralesional curettage.

Keywords: Bone cement; Curettage; Giant cell tumor of bone; Sacrum; Zoledronic acid.