TREATMENT OF GIANT-CELL TUMOR OF THE PELVIS

Nineteen patients who had a giant-cell tumor of the pelvis were manage d from 1944 through 1989. Thirteen of the patients were in the third o r fourth decade of life. The ilium was involved in thirteen patients; the pubis, in two; the ischium, in three; and the pubis and ischium, i n one. Five patients who had an initial Stage-II (active) lesion were managed with curettage; in one of the five, a local recurrence develop ed at twelve months, and the other four had no evidence of disease fro m nine to forty-six years after the curettage. Eight patients who had a Stage-III (aggressive) lesion were managed with resection of most of the lesion followed by curettage of any remaining positive margins; f our of the eight also received adjuvant irradiation. None of the eight had a local recurrence; six had no evidence of disease from eight to twenty-seven years after the operation, one died because of a metastat ic post-radiation sarcoma thirteen years after the operation, and one was asymptomatic but had pulmonary metastases three years after the op eration. Four patients who had a Stage-III recurrent local tumor when they were first seen were managed with hemipelvectomy, wide resection, resection and curettage, and curettage and arthroplasty (one procedur e each). Three had no evidence of disease seven to twenty years after the operation and one had died because of a post-radiation metastatic osteosarcoma eight years after the operation. Two patients who had Sta ge-III disease were managed with external beam radiation alone. One ha d no evidence of disease twenty-six years later. The other had a recur rence one year later, which was treated with additional irradiation; a second recurrence was treated with curettage and bone-grafting. Twent y-eight years after the initial radiation treatment, this patient had no evidence of disease. External beam irradiation was used for a total of eight patients; a post-radiation sarcoma developed in two.