large GCT of the sacrum by repeated embolization. Nine
consecutive patients underwent angiography and SAE at
time of diagnosis, followed by repeated embolization every
6 weeks until no new vessels were noted, and then 6 and 18
months thereafter. With this procedure tumor progression
was stopped in 7 of 9 cases [35]. We adapted this procedure to
treat a surgically inaccessible local recurrence of the lumbar
spine (case 6). The patient presented with a local recurrence
encasing the abdominal aorta with loss of sensory function
at L4 level 9 months after dorsoventral tumor resection. We
decided to treat him with serial SAE directly after detection of
the recurrence until complete devascularization was achieved
(Figure 3). This procedure was repeated after one and
six months. After the SAE the neurological impairments
completely recovered and the tumor is stable for 19 months
now. This is the first description of successful treatment of a
spinal GCT with serial SAE which might be adopted for other
patients.
In the sacrum most cases were successfully treated by
intralesional curettage and bone cement packing. The high
recurrence rate of 48% of sacral tumors treated by curettage
alone published by Leggon et al. [12] was not confirmed by
our data. Possibly our recurrence rate was lower due to the
use of cementation whenever possible and SAE in some cases.
The role of EBI as primary or adjunct treatment is still
controversially discussed. Despite the relatively high risk of
radiation-induced malignancy [36–40], it is still used by
many. Leggon et al. published a rate of secondary sarcoma of
11% of patients with pelvic or sacral tumors [12], and Sanjay
et al. of 25% in GCT of the pelvis [14]. One of our spine cases
(case 3) and one of our sacrum cases (case 9) received EBI for
adjuvant treatment of a local recurrence. Three patients with
sacral tumors received EBI as an adjunc